纳布啡对结直肠癌根治术后麻醉恢复期的镇痛效果和导尿管相关膀胱刺激征的影响
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摘要
目的评价纳布啡对结直肠癌根治术后麻醉恢复期的镇痛效果和导尿管相关膀胱刺激征的影响。方法选择2017年5月至2018年10月在广元市中心医院接受腹腔镜下结直肠癌根治术的男性患者86例,其中年龄27～77岁,体质量46～72kg,TNM分期Ⅰa～Ⅲc期,美国麻醉医师协会(ASA)分级Ⅱ级或Ⅲ级,按随机数字表法分为两组,纳布啡组(N组)和对照组(C组),每组43例。手术在全麻下进行,术毕送入麻醉恢复室,患者清醒后N组静脉注射纳布啡0. 1mg/kg,C组静脉注射曲马多1mg/kg。记录两组患者入恢复室时(T0)、清醒时给药前(T1)、给药后5min(T2)、给药后30min(T3)的MAP、HR、RR、SPO_2的变化;记录两组患者在T1～T3时视觉模拟评分(VAS评分)、躁动镇静评分(RASS评分)和导尿管膀胱相关刺激征评分(CRBD评分);记录患者在麻醉恢复室期间低血压,心动过缓,恶心、呕吐,舌后坠等并发症的发生情况。结果两组患者年龄、体质量、TNM分期、ASA分级等一般资料和手术时间的比较差异无统计学意义(P>0. 05)。两组患者不同时间点MAP和HR差异有统计学意义(F值分别为:108. 264,113. 452,P<0. 05),与T0比较,C组MAP、HR在T1～T3时间点均升高,N组MAP、HR在T1时间点升高,两组RR在T1～T3时间点均升高,差异有统计学意义(P<0. 05),2组患者各时间点SPO_2比较差异无统计学意义(P>0. 05);与C组比较,N组MAP、HR在T2和T3时间点均降低(P<0. 05)。两组患者在T1时VAS、PASS及CRBD评分差异无统计学意义(P>0. 05);与C组比较,N组在T2和T3时VAS、PASS及CRBD评分降低,差异有统计学意义(P<0. 05);与T1时比较,两组在T2和T3时VAS、PASS及CRBD评分降低,差异有统计学意义(P<0. 05)。两组患者发生舌后坠的情况N组有2例(4. 7%),C组有4例(9. 3%),差异无统计学意义(x~2=0. 717,P>0. 05)。结论纳布啡可减轻腹腔镜下结直肠癌根治术后麻醉恢复期的疼痛程度,预防和降低导尿管相关膀胱刺激征的严重程度,降低术后躁动的发生率。
Objective To evaluate the analgesic effect and catheter-related bladder discomfort during anesthesia recovery period after colorectal cancer surgery. Methods 86 male patients with colorectal cancer underwent laparoscopic radical resection from May 2017 to October 2018 in Guangyuan Central Hospital,aged 27-77 years,weighing 46-72 kg,TNM stage I a-III c,and ASA physical status II or III,were divided into two groups according to random number table,nalbuphine group( group N) and control group( group C),43 cases in each group. The operation was carried out under general anesthesia and was sent to anesthesia recovery room after operation. After awakening,the patients were intravenously injected with nalbuphine 0. 1 mg/kg in group N or tramadol 1 mg/kg in group C. The MAP,HR,RR and SPO_2 were recorded at the time of admission to the recovery room( T0),before administration when awake( T1),5 minutes after administration( T2),30 minutes after administration( T3). Visual analogue score( VAS),restlessness and sedation score( RASS) and catheter bladder related discomfort score( CRBD) were recorded at the time of T1-T3 in both groups. The occurrence of complications such as hypotension,bradycardia,nausea,vomiting and tongue drop during anesthesia recovery room was also recorded. Results There was no significant difference in age,weight,TNM stage,ASA grade and operation time between the two groups( P>0. 05). There were differences in MAP and HR between two groups at different time points( F values: 108. 264,113. 452,P<0. 05),compared with T0,MAP and HR in group C were increased at the time of T1-T3,MAP and HR in group N was increased at T1,RR in group N was increased at the time of T1-T3( P<0. 05),and there was no significant difference in SPO_2 at each time point of the two groups( P>0. 05). Compared with group C,MAP and HR in group N was decreased at time points of T2 and T3( P<0. 05). There was no significant difference in VAS,PASS and CRBD scores at T1 between the two groups( P>0. 05). Compared with group C,VAS,PASS and CRBD scores at T2 and T3 were decreased in group N( P<0. 05). Compared with group T1,VAS,PASS and CRBD scores at T2 and T3 were decreased in two groups( P<0. 05). There were 2 cases( 4. 7%) glossocoma in group N and 4 cases( 9. 3%) in group C. There was no significant difference between the two groups( x~2= 0. 717,P>0. 05). Conclusion Nalbuphine can alleviate the pain during anesthesia recovery period after laparoscopic radical resection of colorectal cancer,prevent and reduce the severity of urethral-related bladder discomfort,and reduce the incidence of postoperative agitation.
Objective To evaluate the analgesic effect and catheter-related bladder discomfort during anesthesia recovery period after colorectal cancer surgery. Methods 86 male patients with colorectal cancer underwent laparoscopic radical resection from May 2017 to October 2018 in Guangyuan Central Hospital,aged 27-77 years,weighing 46-72 kg,TNM stage I a-III c,and ASA physical status II or III,were divided into two groups according to random number table,nalbuphine group( group N) and control group( group C),43 cases in each group. The operation was carried out under general anesthesia and was sent to anesthesia recovery room after operation. After awakening,the patients were intravenously injected with nalbuphine 0. 1 mg/kg in group N or tramadol 1 mg/kg in group C. The MAP,HR,RR and SPO_2 were recorded at the time of admission to the recovery room( T0),before administration when awake( T1),5 minutes after administration( T2),30 minutes after administration( T3). Visual analogue score( VAS),restlessness and sedation score( RASS) and catheter bladder related discomfort score( CRBD) were recorded at the time of T1-T3 in both groups. The occurrence of complications such as hypotension,bradycardia,nausea,vomiting and tongue drop during anesthesia recovery room was also recorded. Results There was no significant difference in age,weight,TNM stage,ASA grade and operation time between the two groups( P>0. 05). There were differences in MAP and HR between two groups at different time points( F values: 108. 264,113. 452,P<0. 05),compared with T0,MAP and HR in group C were increased at the time of T1-T3,MAP and HR in group N was increased at T1,RR in group N was increased at the time of T1-T3( P<0. 05),and there was no significant difference in SPO_2 at each time point of the two groups( P>0. 05). Compared with group C,MAP and HR in group N was decreased at time points of T2 and T3( P<0. 05). There was no significant difference in VAS,PASS and CRBD scores at T1 between the two groups( P>0. 05). Compared with group C,VAS,PASS and CRBD scores at T2 and T3 were decreased in group N( P<0. 05). Compared with group T1,VAS,PASS and CRBD scores at T2 and T3 were decreased in two groups( P<0. 05). There were 2 cases( 4. 7%) glossocoma in group N and 4 cases( 9. 3%) in group C. There was no significant difference between the two groups( x~2= 0. 717,P>0. 05). Conclusion Nalbuphine can alleviate the pain during anesthesia recovery period after laparoscopic radical resection of colorectal cancer,prevent and reduce the severity of urethral-related bladder discomfort,and reduce the incidence of postoperative agitation.
引文
[1]张桂祥,周家军,陈建曙.3D腹腔镜下结直肠癌根治术对患者免疫功能及生理功能的影响[J].广西医科大学学报,2018,35(10):1358-1362.
[2]丁成明,彭健,邱俊,等.经自然腔道取标本完全腹腔镜下结直肠癌根治术的临床效果分析(附50例报道)[J].中国内镜杂志,2018,24(6):97-101.
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[5]张振,罗辉宇,徐阳,等.丙泊酚分别复合盐酸纳布啡、地佐辛、舒芬太尼、用于无痛胃镜的效果比较[J].中国药房,2017,28(3):315-317.
[6]杨鑫,沈荣荣,李琳,等.帕瑞昔布钠超前镇痛预防全麻苏醒期导尿管源性躁动的效果[J].中国医药导报,2017,14(1):73-77.
[7]孙晶,胡薇,郑钊,等.地佐辛与纳布啡用于剖宫产术后静脉自控镇痛的临床观察[J].中国药房,2018,29(12):1678-1681.
[8]颜娅,何才,戴珩,等.不同剂量纳布啡联合芬太尼对腹腔镜子宫肌瘤挖除术患者术后镇痛的效果分析[J].第三军医大学学报,2018,40(17):1595-1598.
[9]朱永满,徐惠芳,江伟.等效剂量曲马多、吗啡或芬太尼用于老年病人术后静脉镇痛的临床研究[J].临床麻醉学杂志,2001,17(11):596-598.
[10]Lisa F Potts,Eun S Park,Jong-Min Woo,et al.Dualκ-agonist/μ-antagonist opioid receptor modulation reduces levodopa-induced dyskinesia and corrects dysregulated striatal changes in the nonhuman primate model of Parkinson disease[J].Annals of neurology,2015,77(6):930-941.
[11]吴海涛,江涌,张晓冬,等.载脂蛋白E基因多态性影响星形胶质细胞损伤后早期NF-κB表达的实验研究[J].第三军医大学学报,2010,32(2):103-106.
[12]鲁义,欧益金,周朴,等.不同剂量TAK-242对大鼠糖尿病周围神经痛的治疗效果[J].国际麻醉学与复苏杂志,2018,39(9):809-813.
[13]Shaohua Liu,Youdong Wan,Yonggang Luo,et al.Efficacy and safety of nalbuphine on analgesia of patients in intensive care unit[J].Zhonghua wei zhong bing ji jiu yi xue,2018,30(5):471-476.
[14]郭伟兵,李文君,段姣,等.羟考酮与吗啡在大鼠内脏痛镇痛效应的差异[J].东南国防医药,2018,20(4):365-370.
[2]丁成明,彭健,邱俊,等.经自然腔道取标本完全腹腔镜下结直肠癌根治术的临床效果分析(附50例报道)[J].中国内镜杂志,2018,24(6):97-101.
[3]Kim HC,Kim E,Jeon YT,et al.Postanaesthetic emergence agitation in adult patients after general anaesthesia for urological surgery[J].J Int Med Res,2015,43(2):226-235.
[4]Akca Basak,Aydogan-Eren Emel,Canbay Ozgür,et al.Comparison of efficacy of prophylactic ketamine and dexmedetomidine on postoperative bladder catheter-related discomfort[J].Saudi Medical Journal,2016,37(1):55-59.
[5]张振,罗辉宇,徐阳,等.丙泊酚分别复合盐酸纳布啡、地佐辛、舒芬太尼、用于无痛胃镜的效果比较[J].中国药房,2017,28(3):315-317.
[6]杨鑫,沈荣荣,李琳,等.帕瑞昔布钠超前镇痛预防全麻苏醒期导尿管源性躁动的效果[J].中国医药导报,2017,14(1):73-77.
[7]孙晶,胡薇,郑钊,等.地佐辛与纳布啡用于剖宫产术后静脉自控镇痛的临床观察[J].中国药房,2018,29(12):1678-1681.
[8]颜娅,何才,戴珩,等.不同剂量纳布啡联合芬太尼对腹腔镜子宫肌瘤挖除术患者术后镇痛的效果分析[J].第三军医大学学报,2018,40(17):1595-1598.
[9]朱永满,徐惠芳,江伟.等效剂量曲马多、吗啡或芬太尼用于老年病人术后静脉镇痛的临床研究[J].临床麻醉学杂志,2001,17(11):596-598.
[10]Lisa F Potts,Eun S Park,Jong-Min Woo,et al.Dualκ-agonist/μ-antagonist opioid receptor modulation reduces levodopa-induced dyskinesia and corrects dysregulated striatal changes in the nonhuman primate model of Parkinson disease[J].Annals of neurology,2015,77(6):930-941.
[11]吴海涛,江涌,张晓冬,等.载脂蛋白E基因多态性影响星形胶质细胞损伤后早期NF-κB表达的实验研究[J].第三军医大学学报,2010,32(2):103-106.
[12]鲁义,欧益金,周朴,等.不同剂量TAK-242对大鼠糖尿病周围神经痛的治疗效果[J].国际麻醉学与复苏杂志,2018,39(9):809-813.
[13]Shaohua Liu,Youdong Wan,Yonggang Luo,et al.Efficacy and safety of nalbuphine on analgesia of patients in intensive care unit[J].Zhonghua wei zhong bing ji jiu yi xue,2018,30(5):471-476.
[14]郭伟兵,李文君,段姣,等.羟考酮与吗啡在大鼠内脏痛镇痛效应的差异[J].东南国防医药,2018,20(4):365-370.