纳布啡复合丙泊酚泵注麻醉对肠道经内镜黏膜下剥离术患者血流动力学和应激反应的影响
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摘要
目的探讨纳布啡复合丙泊酚泵注麻醉对肠道经内镜黏膜下剥离术(ESD)患者血流动力学和应激反应的影响。方法选取2017年9—12月南京医科大学第二附属医院收治的择期行肠道ESD患者200例,采用随机数字表法将患者分为观察组和对照组,各100例。对照组采取舒芬太尼复合丙泊酚泵注麻醉,观察组采取纳布啡复合丙泊酚泵注麻醉。比较2组患者麻醉前5 min(T_0)、麻醉开始时(T_1)、手术开始5 min(T_2)、手术开始30 min(T_3)及术毕拔管时(T_4)的心率、收缩压、舒张压、脉搏血氧饱和度(SpO_2)等血流动力学指标及去甲肾上腺素(NE)、皮质醇、血糖水平等应激反应指标的变化情况。记录2组患者丙泊酚用量、麻醉唤醒时间、完全苏醒时间、术后疼痛视觉模拟量表评分及麻醉后不良反应发生情况。结果与T_0时点相比,2组患者T_1～T_3时点心率、收缩压、舒张压以及SpO_2均有所降低,观察组T_1～T_3时点的SpO_2高于对照组,差异均有统计学意义(均P <0. 05)。与T_0时点相比,2组患者T_1～T_4时点的NE、皮质醇、血糖水平均明显升高,且观察组T_1～T_4时点的NE、皮质醇、血糖水平均低于对照组,差异均有统计学意义(均P <0. 05)。2组患者丙泊酚用量、麻醉唤醒时间、完全苏醒时间和术后疼痛视觉模拟量表评分比较,差异均无统计学意义(均P> 0. 05)。观察组呛咳、呼吸抑制及恶心呕吐发生率均低于对照组[1. 0%(1/100)比8. 0%(8/100)、1. 0%(1/100)比21. 0%(21/100)、7. 0%(7/100)比27. 0%(27/100)],差异均有统计学意义(均P <0. 05)。结论肠道ESD患者应用纳布啡复合丙泊酚泵注麻醉,对血流动力学和应激反应的影响较小,不良反应少,是一种相对安全有效的麻醉配伍方法。
Objective To investigate the effect of nalbuphine combined with propofol anesthesia on hemodynamics and stress response in patients undergoing intestinal endoscopic mucosal dissection( ESD). Methods From September to December 2017,200 patients undergoing intestinal ESD in the Second Affiliated Hospital of Nanjing Medical University were randomly divided into observation group and control group,with 100 patients in each group. The control group had sufentanil combined with propofol anesthesia. The observation group had nalbuphine combined with propofol anesthesia. Heart rate,systolic blood pressure,diastolic blood pressure,pulse oxygen saturation( SpO_2),levels of noradrenaline,cortisol and blood glucose were analyzed 5 min before anesthesia( T_0),at the beginning of anesthesia( T_1),5 min during operation( T_2),30 min during operation( T_3) and during extubation( T_4). Dosage of propofol,postanesthetic arousal time,waking time,Visual Analogue Scale score of pain and adverse reactions were analyzed. Results At T_1-T_3,heart rate,systolic blood pressure,diastolic blood pressure and SpO_2 significantly decreased in both groups compared to those at T_0; SpO_2 in observation group was significantly higher than that in control group( all P < 0. 05). At T_1-T_4,levels of noradrenaline,cortisol and blood glucose significantly increased in both groups and the levels in observation group were significantly lower than those in control group( all P < 0. 05). There was no significant difference of propofol dosage,postanesthesia arousal time,waking time and pain score between groups( P > 0. 05). Incidences of cough,respiratory depression,postoperative nausea and vomiting in observation group were lower than those in control group[1. 0%( 1/100) vs 8. 0%( 8/100),1. 0%( 1/100) vs 21. 0%( 21/100),7. 0%( 7/100) vs 27. 0%( 27/100) ]( all P < 0. 05). Conclusions Intravenous anesthesia with nalbuphine combined with propofol pump has few effect on hemodynamics,stress response and few adverse reactions in patients with ESD. It is a safe and effective method of anesthesia compatibility.
Objective To investigate the effect of nalbuphine combined with propofol anesthesia on hemodynamics and stress response in patients undergoing intestinal endoscopic mucosal dissection( ESD). Methods From September to December 2017,200 patients undergoing intestinal ESD in the Second Affiliated Hospital of Nanjing Medical University were randomly divided into observation group and control group,with 100 patients in each group. The control group had sufentanil combined with propofol anesthesia. The observation group had nalbuphine combined with propofol anesthesia. Heart rate,systolic blood pressure,diastolic blood pressure,pulse oxygen saturation( SpO_2),levels of noradrenaline,cortisol and blood glucose were analyzed 5 min before anesthesia( T_0),at the beginning of anesthesia( T_1),5 min during operation( T_2),30 min during operation( T_3) and during extubation( T_4). Dosage of propofol,postanesthetic arousal time,waking time,Visual Analogue Scale score of pain and adverse reactions were analyzed. Results At T_1-T_3,heart rate,systolic blood pressure,diastolic blood pressure and SpO_2 significantly decreased in both groups compared to those at T_0; SpO_2 in observation group was significantly higher than that in control group( all P < 0. 05). At T_1-T_4,levels of noradrenaline,cortisol and blood glucose significantly increased in both groups and the levels in observation group were significantly lower than those in control group( all P < 0. 05). There was no significant difference of propofol dosage,postanesthesia arousal time,waking time and pain score between groups( P > 0. 05). Incidences of cough,respiratory depression,postoperative nausea and vomiting in observation group were lower than those in control group[1. 0%( 1/100) vs 8. 0%( 8/100),1. 0%( 1/100) vs 21. 0%( 21/100),7. 0%( 7/100) vs 27. 0%( 27/100) ]( all P < 0. 05). Conclusions Intravenous anesthesia with nalbuphine combined with propofol pump has few effect on hemodynamics,stress response and few adverse reactions in patients with ESD. It is a safe and effective method of anesthesia compatibility.
引文
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[8]陈元良,徐丽丽,蓝志坚,等.七氟烷与丙泊酚复合瑞芬太尼对老年食管癌根治术后血流动力学水平的影响[J].中华全科医学,2017,15(2):198-201. DOI:10. 16766/j. cnki. issn. 1674-4152. 2017. 02. 005.Chen YL,Xu LL,Lan ZJ,et al. Effects of sevoflurane and propofol combined with remifentanil on hemodynamics in elderly patients with esophageal cancer after radical operation[J]. Chinese Journal of General Practice,2017,15(2):198-201. DOI:10. 16766/j. cnki.issn. 1674-4152. 2017. 02. 005.
[9]陈莹莹,张宗泽,刘汉兴,等.氢吗啡酮或羟考酮复合丙泊酚对结肠镜诊疗术后患者认知功能的影响[J].贵州医科大学学报,2017,42(2):194-197. DOI:10. 19367/j. cnki. 1000-2707.2017. 02. 016.Chen YY,Zhang ZZ,Liu HX,et al. Effect of oxycodone hydrochloride or hydromorphone compound propofol on early postoperative cognitive function of patients underwent colonoscopic treatment[J].Journal of Guizhou Medical University,2017,42(2):194-197.DOI:10. 19367/j. cnki. 1000-2707. 2017. 02. 016.
[10]周俊辉,孟睿,刘晓乐,等.纳布啡复合丙泊酚用于无痛结肠镜检查术的临床效果[J].医学研究杂志,2017,46(2):112-116.DOI:10. 11969/j. issn. 1673-548X. 2017. 02. 029.Zhou JH,Meng R,Liu XL,et al. Clinical effect of nabufen combined with propofol in painless colonoscopy[J]. Journal of Medical Research,2017,46(2):112-116. DOI:10. 11969/j.issn. 1673-548X. 2017. 02. 029.
[2]王磊,董铁立.纳布啡复合丙泊酚用于无痛人工流产术麻醉及术后镇痛效果观察[J].河南外科学杂志,2017,23(6):71-73.Wang L,Dong TL. Observation on the anesthesia and postoperative analgesia effect of nabufen combined with propofol in painless induced abortion[J]. Henan Journal of Surgery,2017,23(6):71-73.
[3]初阳,孙刚.不同剂量纳布啡联合丙泊酚对宫腔镜手术患者麻醉和镇痛效果的影响[J].中国药房,2017,28(35):4955-4959.DOI:10. 6039/j. issn. 1001-0408. 2017. 35. 16.Chu Y,Sun G. Effects of different doses of nabufen combined with propofol on anesthesia and analgesia in patients undergoing hysteroscopy[J]. China Pharmacy,2017,28(35):4955-4959. DOI:10. 6039/j. issn. 1001-0408. 2017. 35. 16.
[4]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):315-318. DOI:10. 6039/j. issn. 1001-0408. 2017. 03. 08.Zhang Z,Luo HY,Xu Y,et al. Comparison of the efficacy of propofol respectively combined with nalbuphine hydrochloride,dezocine and fentanyl for painless gastroscopy[J]. China Pharmacy,2017,28(3):315-318. DOI:10. 6039/j. issn. 1001-0408. 2017.03. 08.
[5]Kim TJ,Kim ER,Hong SN,et al. Current practices in endoscopic submucosal dissection for colorectal neoplasms:a survey of indications among Korean endoscopists[J]. Intest Res,2017,15(2):228-235. DOI:10. 5217/ir. 2017. 15. 2. 228.
[6]Kim EK,Han DS,Ro Y,et al. The submucosal fibrosis:what does it mean for colorectal endoscopic submucosal dissection?[J]. Intest Res,2016,14(4):358-364. DOI:10. 5217/ir. 2016. 14. 4. 358.
[7]苗素琴,张琼,申培培.丙泊酚麻醉在胃癌内镜黏膜下剥离术中的安全性和有效性研究[J].实用癌症杂志,2016,31(9):1445-1447,1458. DOI:10. 3969/j. issn. 1001-5930. 2016.09. 018.Miao SQ,Zhang Q,Shen PP. Safety and effectiveness of propofol anesthesia in endoscopic submucosal dissection for gastric cancer[J].The Practical Journal of Cancer,2016,31(9):1445-1447,1458.DOI:10. 3969/j. issn. 1001-5930. 2016. 09. 018.
[8]陈元良,徐丽丽,蓝志坚,等.七氟烷与丙泊酚复合瑞芬太尼对老年食管癌根治术后血流动力学水平的影响[J].中华全科医学,2017,15(2):198-201. DOI:10. 16766/j. cnki. issn. 1674-4152. 2017. 02. 005.Chen YL,Xu LL,Lan ZJ,et al. Effects of sevoflurane and propofol combined with remifentanil on hemodynamics in elderly patients with esophageal cancer after radical operation[J]. Chinese Journal of General Practice,2017,15(2):198-201. DOI:10. 16766/j. cnki.issn. 1674-4152. 2017. 02. 005.
[9]陈莹莹,张宗泽,刘汉兴,等.氢吗啡酮或羟考酮复合丙泊酚对结肠镜诊疗术后患者认知功能的影响[J].贵州医科大学学报,2017,42(2):194-197. DOI:10. 19367/j. cnki. 1000-2707.2017. 02. 016.Chen YY,Zhang ZZ,Liu HX,et al. Effect of oxycodone hydrochloride or hydromorphone compound propofol on early postoperative cognitive function of patients underwent colonoscopic treatment[J].Journal of Guizhou Medical University,2017,42(2):194-197.DOI:10. 19367/j. cnki. 1000-2707. 2017. 02. 016.
[10]周俊辉,孟睿,刘晓乐,等.纳布啡复合丙泊酚用于无痛结肠镜检查术的临床效果[J].医学研究杂志,2017,46(2):112-116.DOI:10. 11969/j. issn. 1673-548X. 2017. 02. 029.Zhou JH,Meng R,Liu XL,et al. Clinical effect of nabufen combined with propofol in painless colonoscopy[J]. Journal of Medical Research,2017,46(2):112-116. DOI:10. 11969/j.issn. 1673-548X. 2017. 02. 029.