纳布啡联合舒芬太尼对全麻插管期间患者血浆肾上腺素和去甲肾上腺素的影响
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摘要
目的观察纳布啡联合舒芬太尼对全麻插管期间患者血浆肾上腺素和去甲肾上腺素的影响。方法选取2018年4-10月我院择期手术患者80例,美国麻醉医师协会(ASA)分级I～Ⅱ级,采用随机数字表法分为2组(每组40例):对照组(C组)、纳布啡组(N组)。N组患者静脉给予纳布啡0.2 mg/kg,C组患者给予等量的生理盐水。给药后2 min进行全麻诱导,待肌肉完全松弛,明视下气管插管。记录6个时间点:给药前(T_0)、麻醉诱导前(T_1)、气管插管前(T_2)、插管即刻(T_3)、插管后1 min(T_4)、插管后5 min(T_5)的收缩压(SBP)、舒张压(DBP)和心率(HR)。于T_0、T_2、T_3、T_4、T_5时间点抽取静脉血,采用ELISA法检测去甲肾上腺素(NE)、肾上腺素(E)浓度。观察并记录各组患者诱导期舒芬太尼呛咳发生情况。结果 T_2时间点C组患者HR明显低于N组,差异有统计学意义(P<0.05)。T_3、T_4、T_5时间点,C组患者SBP、DBP、HR明显高于N组,差异有统计学意义(P<0.05)。T_3、T_4、T_5时间点,C组患者NE和E浓度明显高于N组,差异有统计学意义(P<0.05)。N组患者均未发生呛咳,C组有12例患者发生呛咳(轻度7.5%、中度10%、重度12.5%),两组比较差异有统计学意义(P<0.05)。结论纳布啡0.2 mg/kg联合舒芬太尼能有效抑制全麻气管插管期血浆肾上腺素和去甲肾上腺素的分泌,可安全有效地用于全麻诱导期。
Objective To observe the effects of nalbuphine combined with sufentanil on plasma epinephrine(E) and norepirrephrine(NE) during general anesthesia intubation.Methods Totally 80 patients admitted to our hospital undergoing elective surgery from April to October in 2018 were chosen.According to the ASA grading(Ⅰ～Ⅱ),80 patients were randomly divided into two groups:control group(group C) and nalbuphine group(group N),40 patients in each group.Patients in control group received 5 ml normal saline and nalbuphine group received nalbuphine at 0.2 mg/kg.After 2 min,the patient underwent general anesthesia induction.Endotracheal intubation was given to the patient after muscles were completely relaxed.The systolic blood pressure(SBP),diastolic blood pressure(DBP) and heart rate(HR) of patients were recorded before administration(T_0),immediately before general anesthesia induction(T_1),before intubation(T_2),at the time of intubation(T_3),1 min after intubation(T_4),and 5 min after intubation(T_5).Blood samples were taken at T_0,T_2,T_3,T_4 and T_5 for determination of plasma concentration of NE and E using the method of ELISA.The incidence and severity of cough in patients were evaluated during general anesthesia induction.Results HR of group C at T_2 was obviously lower than that of group N(P<0.05).The SBP,DBP and HR in group N were obviously lower than those of control group at T_3,T_4 and T_5(P<0.05).The concentration of E and NE were obviously lower than those of control group at T_3,T_4 and T_5(P<0.05).No cough happened in group N,while there were 12 patients with cough in group C(severity of cough:mild,7.5%;moderate,10%;severe,12.5%)(P<0.05).Conclusion Nabuphine 0.2 mg/kg combined with sufentanil can effectively inhibit the secretion of plasma E and NE during the intubation of general anesthesia,which can be safely and effectively used in the induction period of general anesthesia.
Objective To observe the effects of nalbuphine combined with sufentanil on plasma epinephrine(E) and norepirrephrine(NE) during general anesthesia intubation.Methods Totally 80 patients admitted to our hospital undergoing elective surgery from April to October in 2018 were chosen.According to the ASA grading(Ⅰ～Ⅱ),80 patients were randomly divided into two groups:control group(group C) and nalbuphine group(group N),40 patients in each group.Patients in control group received 5 ml normal saline and nalbuphine group received nalbuphine at 0.2 mg/kg.After 2 min,the patient underwent general anesthesia induction.Endotracheal intubation was given to the patient after muscles were completely relaxed.The systolic blood pressure(SBP),diastolic blood pressure(DBP) and heart rate(HR) of patients were recorded before administration(T_0),immediately before general anesthesia induction(T_1),before intubation(T_2),at the time of intubation(T_3),1 min after intubation(T_4),and 5 min after intubation(T_5).Blood samples were taken at T_0,T_2,T_3,T_4 and T_5 for determination of plasma concentration of NE and E using the method of ELISA.The incidence and severity of cough in patients were evaluated during general anesthesia induction.Results HR of group C at T_2 was obviously lower than that of group N(P<0.05).The SBP,DBP and HR in group N were obviously lower than those of control group at T_3,T_4 and T_5(P<0.05).The concentration of E and NE were obviously lower than those of control group at T_3,T_4 and T_5(P<0.05).No cough happened in group N,while there were 12 patients with cough in group C(severity of cough:mild,7.5%;moderate,10%;severe,12.5%)(P<0.05).Conclusion Nabuphine 0.2 mg/kg combined with sufentanil can effectively inhibit the secretion of plasma E and NE during the intubation of general anesthesia,which can be safely and effectively used in the induction period of general anesthesia.
引文
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[12] 赵聚钊,王洪武,王鹤昕,等.心功能不全老年患者急诊非手术下行气管插管的麻醉处理[J].中华危重病急救医学,2014,26(10):750-751.
[13] 胡利国,潘建辉,李娟,等.瑞芬太尼联合舒芬太尼在老年患者全麻中的镇痛作用[J].临床麻醉学杂志,2013,29(2):133-136.
[14] 李娜,陈勇,林冠文,等.复合七氟醚时舒芬太尼抑制患儿气管插管反应的剂量-效应关系[J].中华麻醉学杂志,2014,34(6)721-723.
[15] 彭文平,王巧恒,左明章,等.复合异丙酚时舒芬太尼抑制双腔支气管导管插管反应的半数有效剂量[J].中华麻醉学杂志,2015,35(12):1470-1472.
[16] 孙申,黄绍强.不同剂量右美托咪啶预防舒芬太尼诱发患者全麻诱导期间呛咳反应的可行性[J].中华麻醉学杂志,2011,31(5):539-541.
[17] 吴希珠,郑晓春,李荣钢,等.舒芬太尼单次静脉注射引起呼吸抑制的半数有效剂量[J].临床麻醉学杂志,2013,29(7):652-654.
[18] 於桥,陈春.盐酸纳布啡的特点及临床应用现状[J].中国医药导报,2017,14(28):38-41.
[19] 毕小宝,王琼,张高龙,等.纳布啡与舒芬太尼用于宫腔镜手术的麻醉效果比较[J].实用医学杂志,2018,34(18):109-112.
[20] 王璐,陈伟,谢文杰,等.纳布啡对多发伤患者的镇痛效果及对睡眠质量的影响[J].中国医药,2018,13(12):120-123.
[21] 初阳,孙刚.纳布啡复合丙泊酚用于老年患者无痛胃镜联合结肠镜检查术的麻醉效果[J].中国医药,2017,12(6):892-896.
[22] Jannuzzi RG.Nalbuphine for treatment of opioid-induced pruritus:a systematic review of literature[J].Clin J Pain,2016 32(1):87-93.
[23] Moustafa AM,Baaror AS,Abdelazim I.Comparative study between nalbuphine and ondansetron in prevention of intrathecal morphine-induced pruritus in women undergoing cesarean section[J].Anesth Essays Res,2016,10(2):238-244.
[24] 饶艳,王焱林,柯剑娟,等.不同剂量布托啡诺对全麻患者气管插管心血管反应的影响[J].中华麻醉学杂志,2009,29(3):279-280.
[2] 王雯,傅润乔.喉镜和气管插管应激反应的产生和预防[J].临床麻醉学杂志,2013,29(8):817-819.
[3] 庞倩芸,熊章荣,刘红亮.右美托咪定复合舒芬太尼术后镇痛对肺癌患者免疫功能及肺部并发症的影响[J].国际麻醉学与复苏杂志,2017,38(2):110.
[4] Bershad AK,Seiden JA,Wit HD .Effects of buprenorphine on responses to social stimuli in healthy adults[J].Psychoneuroendocrinology,2015,63:43-49.
[5] Breivik H,Werner MU.Combining an oral opioid-receptor agonist and the antagonist naloxone:a smart drug design that removes some but not all adverse effects of the opioid analgesic[J].Scandinavian J Pain,2014,5(2):72-74.
[6] Kothari D,Sharma C.Effect of nalbuphine and pentazocine on attenuation of hemodynamic changes during laryngoscopy and endotracheal intubation:a clinical study[J].Anesth:Essays Res,2013,7(3):326-330.
[7] Sadafule NN,Karhade SS.Comparative study of efficacy of preoperative nalbuphine hydrochloride and pentazocine lactate on hemodynamic response to tracheal intubation and postoperative analgesia[J].Anesth Essays Res,2018,12(1):218-222.
[8] 潘雪莲,顾俊峰,罗超.HC可视喉镜在老年患者气管内插管全麻中的应用[J].湖北医药学院学报,2015,34(3):300-302.
[9] 梁青春,杨一梅,周芹,等.不同体质指数患者插管全麻期间呼吸参数的特点[J].实用医学杂志,2018,34(9):105-108.
[10] 王雯,傅润乔.喉镜和气管插管应激反应的产生和预防[J].临床麻醉学杂志,2013,29(8):817-819.
[11] 张懿,苏文君,蒋春雷.应激生理指标皮质醇和 α-淀粉酶的研究进展[J].军事医学,2017,41(2):146-149.
[12] 赵聚钊,王洪武,王鹤昕,等.心功能不全老年患者急诊非手术下行气管插管的麻醉处理[J].中华危重病急救医学,2014,26(10):750-751.
[13] 胡利国,潘建辉,李娟,等.瑞芬太尼联合舒芬太尼在老年患者全麻中的镇痛作用[J].临床麻醉学杂志,2013,29(2):133-136.
[14] 李娜,陈勇,林冠文,等.复合七氟醚时舒芬太尼抑制患儿气管插管反应的剂量-效应关系[J].中华麻醉学杂志,2014,34(6)721-723.
[15] 彭文平,王巧恒,左明章,等.复合异丙酚时舒芬太尼抑制双腔支气管导管插管反应的半数有效剂量[J].中华麻醉学杂志,2015,35(12):1470-1472.
[16] 孙申,黄绍强.不同剂量右美托咪啶预防舒芬太尼诱发患者全麻诱导期间呛咳反应的可行性[J].中华麻醉学杂志,2011,31(5):539-541.
[17] 吴希珠,郑晓春,李荣钢,等.舒芬太尼单次静脉注射引起呼吸抑制的半数有效剂量[J].临床麻醉学杂志,2013,29(7):652-654.
[18] 於桥,陈春.盐酸纳布啡的特点及临床应用现状[J].中国医药导报,2017,14(28):38-41.
[19] 毕小宝,王琼,张高龙,等.纳布啡与舒芬太尼用于宫腔镜手术的麻醉效果比较[J].实用医学杂志,2018,34(18):109-112.
[20] 王璐,陈伟,谢文杰,等.纳布啡对多发伤患者的镇痛效果及对睡眠质量的影响[J].中国医药,2018,13(12):120-123.
[21] 初阳,孙刚.纳布啡复合丙泊酚用于老年患者无痛胃镜联合结肠镜检查术的麻醉效果[J].中国医药,2017,12(6):892-896.
[22] Jannuzzi RG.Nalbuphine for treatment of opioid-induced pruritus:a systematic review of literature[J].Clin J Pain,2016 32(1):87-93.
[23] Moustafa AM,Baaror AS,Abdelazim I.Comparative study between nalbuphine and ondansetron in prevention of intrathecal morphine-induced pruritus in women undergoing cesarean section[J].Anesth Essays Res,2016,10(2):238-244.
[24] 饶艳,王焱林,柯剑娟,等.不同剂量布托啡诺对全麻患者气管插管心血管反应的影响[J].中华麻醉学杂志,2009,29(3):279-280.