氟比洛芬酯联合纳布啡超前镇痛在腹腔镜胆囊切除术中的应用

Application of Flurbiprofen Axetil Combined with Nalbuphine Preemptiue Analgesia in Laparoscopic Cholecystectomy

目的评价氟比洛芬酯联合纳布啡超前镇痛应用于腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中的临床效果。方法回顾性选取2022年8月—2023年10月于洛阳市中心医院接受LC的90例患者的临床资料,依据麻醉药物的不同分为纳布啡组(A组,n=30)、氟比洛芬酯组(B组,n=30)和纳布啡联合氟比洛芬酯组(C组,n=30)。手术切皮前15 min给予超前镇痛药物,A组患者静脉输注纳布啡0.2 mg/kg,B组患者静脉输注氟比洛芬酯2 mg/kg,C组静脉输注纳布啡0.2 mg/kg和氟比洛芬酯2 mg/kg,比较3组患者术后2 h(T1)、术后4 h(T2)、术后12 h(T3)及术后24 h(T4)的视觉模拟评分法(Visual Analogue Scale,VAS)评分,Ramsay镇静评分,手术中使用丙泊酚和瑞芬太尼的剂量、停用药物后的苏醒时间、术后恢复质量评分[采用15项恢复质量(Quality of Recovery-15 Score,QoR-15)量表评估]、术后不良反应发生情况。结果3组患者丙泊酚用量、苏醒时间比较,差异无统计学意义(P均>0.05);C组患者瑞芬太尼用量低于A组和B组,差异有统计学意义(P<0.05)。C组患者T1、T2时间点VAS评分低于A组和B组,差异有统计学意义(P均<0.05);3组患者T3、T4时间点VAS评分比较,差异无统计学意义(P均>0.05)。3组患者T1~T4时间点的Ramsay评分比较,差异无统计学意义(P均>0.05)。C组患者术后第1天和术后第3天QoR-15评分显著高于A组和B组,差异有统计学意义(P均<0.05)。3组患者术后不良反应(恶心、呕吐、寒战、瘙痒和呼吸抑制)发生率比较,差异无统计学意义(P均>0.05)。结论氟比洛芬酯联合纳布啡超前镇痛在LC中可以提供良好的术中镇痛效果,并且能够抑制早期术后疼痛,提高患者术后生活质量,加速康复,联合应用安全性高,可以为腹腔镜下胆囊切除患者围术期镇痛管理提供参考。

Objective To evaluate the clinical efficacy of flurbiprofen axetil combined with nalbuphine for preemptive analgesia in laparoscopic cholecystectomy(LC).Methods Clinical data of 90 patients undergoing LC in Luoyang Central Hospital from August 2022 to October 2023 were retrospectively selected.They were divided into nalbuphine group(group A,n=30),flurbiprofen exate group(group B,n=30)and nalbuphine combined with flurbiprofen exate group(group C,n=30)according to different narcotic drugs.Pre-analgesic drugs were given 15 min before surgical incision.Patients in group A were given intravenous infusion of nalbuphine 0.2 mg/kg,patients in group B were given intravenous infusion of flurbiprofen ester 2 mg/kg,and patients in group C were given intravenous infusion of nalbuphine 0.2 mg/kg and flurbiprofen ester 2 mg/kg.Visual Analogue Scale(VAS)scores and Ramsay sedation scores were obtained 2 h(T1),4 h(T2),12 h(T3)and 24 h(T4)after surgery,the dose of propofol and remifentanil used during surgery,the time to recovery after discontinuation of the drug,the score of postoperative recovery quality[assessed by Quality of Recovery-15 Score(QoR-15)scale],and the incidence of postoperative adverse reactions of three groups were compared.Results There was no significant difference in the dosage of propofol and recovery time among 3 groups(both P>0.05).The dosage of remifentanil in group C was lower than that in group A and group B,and the difference was statistically significant(P<0.05).The VAS scores at T1 and T2 time points in group C were lower than those in group A and group B,and the differences were statistically significant(both P<0.05).There was no significant difference in T3 and T4 VAS scores among 3 groups(both P>0.05).There was no significant difference in Ramsay score at T1 to T4 in 3 groups(all P>0.05).The QoR-15 scores in group C were significantly higher than those in group A and group B on the 1st and 3rd day after surgery,the differences were statistically significant(both P<0.05).There was no significant difference in the total incidence of postoperative adverse reactions(nausea,vomiting,chills,pruritus and respiratory depression)among 3 groups(all P>0.05).Conclusion Flurbiprofen axetil combined with nalbuphine can provide good intraoperative analgesia effect in LC,and can inhibit early postoperative pain,improve postoperative quality of life and accelerate recovery.The combined application has high safety,and can provide reference for perioperative analgesia management in patients with laparoscopic cholecystectomy.