纳布啡用于鼻内镜术后镇痛的临床效果

Clinical Efficacy of Postoperative Intravenous Patient Controlled Analgesia with Nalbuphine After Nasal Endoscopic Surgery

目的:探究纳布啡用于鼻内镜术后静脉患者自控镇痛(PCA)的临床效果。方法:全麻下择期行鼻内镜手术的患者80例随机分为两组,术后实施静脉PCA。镇痛药:N组为纳布啡100mg+托烷司琼10mg,S组为舒芬太尼100μg+托烷司琼10mg,均用生理盐水稀释到100ml。镇痛泵参数:首剂量2ml,背景剂量2ml/h,PCA剂量2ml/次,锁定时间15min。记录患者一般情况,包括年龄、性别、体质量指数(BMI)、手术类别、手术时间及停药至拔管时间(拔管时间);记录术后0.5,2,6,12h疼痛程度及不良反应发生例数,记录镇痛泵用药总量和按压总次数及使用补救性镇痛药物盐酸曲马多(单次剂量50mg)次数。疼痛程度用视觉模拟评分定,不良反应包括呼吸抑制、恶心呕吐、嗜睡、躁动和皮肤瘙痒等。结果:(1)患者一般情况两组比较差异无统计学意义(P>0.05);(2)术后0.5,2,6,12h疼痛视觉模拟评分N组和S组比较差异无统计学意义(P>0.05);(3)镇痛泵用药总量和按压总次数及使用补救性镇痛药物盐酸曲马多的次数N组和S组比较差异无统计学意义(P>0.05);(4)术后不良反应的总发生率N组和S组分别为17.50%和43.59%,两组比较差异有统计学意义(P <0.05),未见其他镇痛相关并发症。结论:纳布啡用于鼻内镜术后镇痛静脉患者自控镇痛效果与舒芬太尼无明显差异,且不良反应少,是鼻内镜术后患者自控镇痛的良好选择。

Objective:To explore the clinical efficacy of postoperative intravenous patient controlled analgesia(PCA)with nalbuphine after nasal endoscopic surgery.Methods:A total of 80 patients undergoing nasal endoscopic surgery under general anesthesia was randomly divided into two groups.Intravenous PCA with nalbuphine 100 mg+tropisetron 10 mg(group N)or sufentanil100μg+tropisetron 10 mg(group S)was used,which were diluted with normal saline up to 100 ml.The analgesic variables were set up as a background infusion of 2 ml/h and a bolus dose of 2 ml in a lockout interval of 15 minutes.General conditions of patients were recorded,including age,gender,body mass index,categories of surgery,operation time and extubation time.Levels of pain after 0.5,2,6,12 hwere assessed with Visual Analogue Score(VAS),cases receiving supplementation of pain therapy with tramadol(dose is 50 mg)were recorded,and the total dos-age of administered drug,the total number of press,and adverse reactions including respiratory depression nausea and vomiting,drowsiness,dysphasia and pruritus were recorded too.Results:There was no statistical difference in general clinical data,visual analogue scales,consumed drug volumes,total numbers of press,and dosages of tramadol.In the total side effects of respiratory depression,nausea and vomiting,nalbuphine group showed more cases than sufentanil group(P<0.05).Conclusion:Nalbuphine has similar effect to sufentanil for PCA in the nasal endoscopic surgery but with less side effects,thus nalbuphine is a good option for postoperation analgesia of the nasal endoscopic surgery.