纳布啡与舒芬太尼联合用于腹腔镜胆囊切除术后镇痛对比研究
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摘要
目的:观察盐酸纳布啡联合舒芬太尼在腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)患者自控静脉镇痛(PCIA)中的效果。方法:选取2017年6月-2018年6月在本院行腹腔镜胆囊切除术治疗的102例患者,按随机数字表法将患者分为N组、S组和NS组,每组34例。N组采用纳布啡,S组采用舒芬太尼,NS组采用纳布啡联合舒芬太尼。记录三组患者术后2、6、12、24 h的视觉模拟评分(visual analogue score,VAS)、Ramsay镇静评分,以及24 h内应用其他镇痛药的例数和不良反应发生情况。结果:术后6、12、24 h,NS组VAS评分均低于N组和S组,差异均有统计学意义(P<0.05);而NS组的Ramsay评分均高于N组和S组,差异均有统计学意义(P<0.05)。NS组患者24 h内需要应用其他镇痛药的例数明显少于N组和S组,差异均有统计学意义(P<0.05)。NS组躁动发生率明显低于N组和S组,差异均有统计学意义(P<0.05)。结论:盐酸纳布啡和舒芬太尼联合用于LC患者PCIA的镇静良好,躁动反应少,其他镇痛药的需求量更少,临床效果更满意。
Objective:To observe the clinic effect of combination of Nalbuphine Hydrochloride and Sufentanil on patient controlled intravenous analgesia(PCIA)in patients undergoing laparoscopic cholecystectomy(LC).Method:102 patients of LC surgery in our hospital from June 2017 to June 2018 were selected and divided into group N,group S and group NS according to the random number table method,34 cases in each group.Group N was treated with Nalbuphine,group S was treated with Sufentanil,group NS was treated with Nalbuphine combined with Sufentanil.The VAS score and Ramsay score at 2,6,12 and 24 h after surgery,patients with additional use of analgesics within 24 h and adverse reactions of the medicine among the three groups were observed and recorded.Result:At 6,12 and 24 h after surgery,the VAS scores of group NS were lower than those in group N and group S,the differences were statistically significant(P<0.05);the Ramsay scores of group NS were higher than those in group N and group S,the differences were statistically significant(P<0.05).The number of cases requiring other analgesics within 24 h in group NS was significantly less than those in group N and group S,the differences were statistically significant(P<0.05).The incidence of agitation in group NS was significantly lower than those in group N and group S,the differences were statistically significant(P<0.05).Conclusion:The combination of Nalbuphine Hydrochloride and Sufentanil for PCIA in patients with LC has good sedation,less restlessness,less demand for other analgesics and it has more satisfactory clinical effect.Kezilesu Kirgiz Autonomous Prefecture
Objective:To observe the clinic effect of combination of Nalbuphine Hydrochloride and Sufentanil on patient controlled intravenous analgesia(PCIA)in patients undergoing laparoscopic cholecystectomy(LC).Method:102 patients of LC surgery in our hospital from June 2017 to June 2018 were selected and divided into group N,group S and group NS according to the random number table method,34 cases in each group.Group N was treated with Nalbuphine,group S was treated with Sufentanil,group NS was treated with Nalbuphine combined with Sufentanil.The VAS score and Ramsay score at 2,6,12 and 24 h after surgery,patients with additional use of analgesics within 24 h and adverse reactions of the medicine among the three groups were observed and recorded.Result:At 6,12 and 24 h after surgery,the VAS scores of group NS were lower than those in group N and group S,the differences were statistically significant(P<0.05);the Ramsay scores of group NS were higher than those in group N and group S,the differences were statistically significant(P<0.05).The number of cases requiring other analgesics within 24 h in group NS was significantly less than those in group N and group S,the differences were statistically significant(P<0.05).The incidence of agitation in group NS was significantly lower than those in group N and group S,the differences were statistically significant(P<0.05).Conclusion:The combination of Nalbuphine Hydrochloride and Sufentanil for PCIA in patients with LC has good sedation,less restlessness,less demand for other analgesics and it has more satisfactory clinical effect.Kezilesu Kirgiz Autonomous Prefecture
引文
[1]王翠宝,魏南服,冯宇峰.地佐辛超前镇痛用于全麻腹腔镜胆囊切除术患者的对比研究[J].中国医药指南,2015,13(18):27-29.
[2]Akshat S,Ramachandran R,Rewari V,et al.Morphine versus Nalbuphine for Open Gynaecological Surgery:A Randomized Controlled Double Blinded Trial[J].Pain Res Treat,2014:727952.
[3]Haw A J,Meyer L C,Fuller A.Nalbuphine and butorphanol reverse opioid-induced respiratory depression but increase arousal in etorphine-immobilized goats(Capra hircus)[J].Veterinary Anaesthesia&Analgesia,2016,43(5):539-548.
[4]M??tt?J H,Jaro K,Markus P,et al.Refined phenotyping of modic changes:imaging biomarkers of prolonged severe low back pain and disability[J].Medicine(Baltimore),2016,95(22):e3495.
[5]Lebon J,Fournier F,Bégin F,et al.Subcutaneous fentanyl administration:a novel approach for pain management in a rural and suburban prehospital setting[J].Prehosp Emerg Care,2016,8(1):1-9.
[6]Hines R L,Abram S E.疼痛医学[M].王保国,译.北京:人民卫生出版社,2008:135.
[7]Sun Q,Zhou W,Wu B,et al.Dezocine:a novel drug to prevent fentanyl-induced cough during general anesthesia induction?[J].J Anesth,2012,26(3):470.
[8]Buck L,Varras M N,Miskry T,et al.Intraperitoneal bupivacaine for the reduction of postoperative pain following operative laparoscopy:a pilot study and review of the literature[J].J Obstet Gynaecol,2004,24(4):448-451.
[9]赵红波,殷亚楠,杨小利.舒芬太尼复合瑞芬太尼在小儿扁桃体腺样体手术的临床观察[J].河南外科学杂志,2014,20(4):52-53.
[10]Reinpold W,Schr?der M,Schr?der A,et al.Minimally invasive sublay mesh repair of incisional and primary abdominal wall hernias using the MILOS technique[J].European Surgery,2017,49(2):59-64.
[11]Jyothi B,Shaikh S,Gowda S.A comparison of analgesic effect of different doses of intrathecal nalbuphine hydrochloride with bupivacaine and bupivacaine alone for lower abdominal and orthopedic surgeries[J].Indian Journal of Pain,2014,28(1):18.
[12]French C A,Cong X,Chung K S.Labor epidural analgesia and breastfeeding:a systematic review[J].J Hum Lact,2016,32(3):507-520.
[13]Jannuzzi R G.Nalbuphine for treatment of opioid-induced pruritus:a Systematic Review of Literature[J].Clin J Pain,2016,32(1):87-93.
[14]Coetzee J F,Lechtenberg K F,Stock M L,et al.Pharmacokinetics and effect of intravenous nalbuphine in weaned Holstein calves after surgical castration[J].Journal of Veterinary Pharmacology&Therapeutics,2014,37(2):169-177.
[15]Carvalho B,Granot M,Sultan P,et al.A longitudinal study to evaluate pregnancy-induced endogenous analgesia and pain modulation[J].Reg Anesth Pain Med,2016,41(2):175-180.
[16]Narver H L.Nalbuphine,a non-controlled opioid analgesic,and its potential use in research mice[J].Lab Animal,2015,44(3):106-110.
[17]Youssef M I,Elzayyat N.Lidocaine-nalbuphine versus lidocaine-tramadol for intravenous regional anesthesia[J].AinShams Journal of Anaesthesiology,2014,7(2):198.
[18]Yan L M,Chen H,Yu R G,et al.Emergence agitation during recovery from intracranial surgery under general anaesthesia:a protocol and statistical analysis plan for a prospective multicentre cohort study[J].BMJ Open,2015,5(4):e007542.
[19]Zeng Z,Lu J,Shu C,et al.A comparision of nalbuphine with morphine for analgesic effects and safety:meta-analysis of randomized controlled trials[J].Sci Rep,2015(5):10927.
[20]Haw A J,Meyer L C,Fuller A.Nalbuphine and butorphanol reverse opioid-induced respiratory depression but increase arousal in etorphine-immobilized goats(Capra hircus)[J].Veterinary Anaesthesia&Analgesia,2016,43(5):539-548.
[2]Akshat S,Ramachandran R,Rewari V,et al.Morphine versus Nalbuphine for Open Gynaecological Surgery:A Randomized Controlled Double Blinded Trial[J].Pain Res Treat,2014:727952.
[3]Haw A J,Meyer L C,Fuller A.Nalbuphine and butorphanol reverse opioid-induced respiratory depression but increase arousal in etorphine-immobilized goats(Capra hircus)[J].Veterinary Anaesthesia&Analgesia,2016,43(5):539-548.
[4]M??tt?J H,Jaro K,Markus P,et al.Refined phenotyping of modic changes:imaging biomarkers of prolonged severe low back pain and disability[J].Medicine(Baltimore),2016,95(22):e3495.
[5]Lebon J,Fournier F,Bégin F,et al.Subcutaneous fentanyl administration:a novel approach for pain management in a rural and suburban prehospital setting[J].Prehosp Emerg Care,2016,8(1):1-9.
[6]Hines R L,Abram S E.疼痛医学[M].王保国,译.北京:人民卫生出版社,2008:135.
[7]Sun Q,Zhou W,Wu B,et al.Dezocine:a novel drug to prevent fentanyl-induced cough during general anesthesia induction?[J].J Anesth,2012,26(3):470.
[8]Buck L,Varras M N,Miskry T,et al.Intraperitoneal bupivacaine for the reduction of postoperative pain following operative laparoscopy:a pilot study and review of the literature[J].J Obstet Gynaecol,2004,24(4):448-451.
[9]赵红波,殷亚楠,杨小利.舒芬太尼复合瑞芬太尼在小儿扁桃体腺样体手术的临床观察[J].河南外科学杂志,2014,20(4):52-53.
[10]Reinpold W,Schr?der M,Schr?der A,et al.Minimally invasive sublay mesh repair of incisional and primary abdominal wall hernias using the MILOS technique[J].European Surgery,2017,49(2):59-64.
[11]Jyothi B,Shaikh S,Gowda S.A comparison of analgesic effect of different doses of intrathecal nalbuphine hydrochloride with bupivacaine and bupivacaine alone for lower abdominal and orthopedic surgeries[J].Indian Journal of Pain,2014,28(1):18.
[12]French C A,Cong X,Chung K S.Labor epidural analgesia and breastfeeding:a systematic review[J].J Hum Lact,2016,32(3):507-520.
[13]Jannuzzi R G.Nalbuphine for treatment of opioid-induced pruritus:a Systematic Review of Literature[J].Clin J Pain,2016,32(1):87-93.
[14]Coetzee J F,Lechtenberg K F,Stock M L,et al.Pharmacokinetics and effect of intravenous nalbuphine in weaned Holstein calves after surgical castration[J].Journal of Veterinary Pharmacology&Therapeutics,2014,37(2):169-177.
[15]Carvalho B,Granot M,Sultan P,et al.A longitudinal study to evaluate pregnancy-induced endogenous analgesia and pain modulation[J].Reg Anesth Pain Med,2016,41(2):175-180.
[16]Narver H L.Nalbuphine,a non-controlled opioid analgesic,and its potential use in research mice[J].Lab Animal,2015,44(3):106-110.
[17]Youssef M I,Elzayyat N.Lidocaine-nalbuphine versus lidocaine-tramadol for intravenous regional anesthesia[J].AinShams Journal of Anaesthesiology,2014,7(2):198.
[18]Yan L M,Chen H,Yu R G,et al.Emergence agitation during recovery from intracranial surgery under general anaesthesia:a protocol and statistical analysis plan for a prospective multicentre cohort study[J].BMJ Open,2015,5(4):e007542.
[19]Zeng Z,Lu J,Shu C,et al.A comparision of nalbuphine with morphine for analgesic effects and safety:meta-analysis of randomized controlled trials[J].Sci Rep,2015(5):10927.
[20]Haw A J,Meyer L C,Fuller A.Nalbuphine and butorphanol reverse opioid-induced respiratory depression but increase arousal in etorphine-immobilized goats(Capra hircus)[J].Veterinary Anaesthesia&Analgesia,2016,43(5):539-548.