摘要
目的探讨纳布啡联合右美托咪定对腹腔镜输尿管取石术(LU)后镇痛和炎症因子的影响。方法本研究为随机对照研究,选取2020年1—6月烟台市莱阳中心医院泌尿外科收治的92例行LU的患者,男49例,女43例,年龄(38.6±14.9)岁,年龄范围为22~62岁。采用随机数表法将患者随机分为纳布啡组与联合麻醉组,每组46例。比较两组患者从进入恢复室至术后4、12、24、48 h的视觉模拟评分(VAS)及Ramsay镇静评分,术后1、2、3 d最大疼痛VAS,住院期间每日平均艾瑞昔布用量,患者术后满意度(10分满分),血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平及术后镇痛不良反应。结果联合麻醉组术后4、12、24 h静息VAS[(2.1±0.5)分、(2.7±0.4)分、(3.1±0.4)分]低于纳布啡组[(2.7±0.3)分、(3.1±0.2)分、(3.6±0.3)分],活动VAS[(2.8±0.4)分、(3.3±0.4)分、(3.5±0.3)分]低于纳布啡组[(3.4±0.2)分、(3.6±0.2)分、(3.7±0.4)分],静息Ramsay镇静评分[(2.0±0.3)分、(2.3±0.3)分、(3.0±0.4)分]低于纳布啡组[(2.5±0.5)分、(2.6±0.4)分、(3.3±0.3)分],活动Ramsay镇静评分[(2.8±0.3)分、(3.3±0.3)分、(3.4±0.3)分]低于纳布啡组[(3.2±0.2)分、(3.6±0.2)分、(3.7±0.4)分],术后1、2、3 d最大疼痛VAS[(3.7±0.4)分、(3.5±0.6)分、(2.9±0.4)分]低于纳布啡组[(3.9±0.3)分、(3.8±0.4)分、(3.3±0.5)分],住院期间每日平均艾瑞昔布用量(60 mg)少于纳布啡组(100 mg),患者满意度评分[(9.5±0.4)分]高于纳布啡组[(8.9±0.7)分],差异均有统计学意义(P<0.05)。术后联合麻醉组IL-6[(150.33±19.16)pg/ml]、TNF-α[(38.21±4.78)pg/ml]及CRP水平[(6.74±0.28)mg/ml]均低于纳布啡组[(269.85±27.76)pg/ml、(61.95±6.72)pg/ml、(7.82±0.51)mg/ml],差异有统计学意义(P<0.05)。联合麻醉组不良反应总发生率[30.4%(14/46)]低于纳布啡组[58.7%(27/46)],差异有统计学意义(P<0.05)。结论纳布啡联合右美托咪定对LU进行患者自控镇痛,术后镇痛效果及对术后炎症因子水平的影响优于单独应用纳布啡。
Objective To explore the effect of nalbuphine combined with dexmedetomidine on analgesia and inflammatory factors after laparoscopic ureterolithotomy(LU).Methods This study was a randomized controlled study.A total of 92 patients,including 49 males and 43 females,aged(38.6±14.9)years old,ranging from 22 to 62 years old underwent LU in department of Urology in Yantai Laiyang Central Hospital from January to June 2020 were selected.The patients were randomly divided into nalbuphine group and combined anesthesia group by random number table,there were 46 cases in each group.visual analogue scale(VAS)score and Ramsay sedation score were compared between the two groups from entering the recovery room to 4,12,24 and 48 h after surgery,the maximal pain VAS was obtained at 1,2 and 3 d after operation,average daily icrecoxib dosage during hospitalization,postoperative satisfaction(10 full points),serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)levels,and postoperative analgesic adverse reactions.Results Combined anesthesia group had lower resting VAS score[(2.1±0.5)points,(2.7±0.4)points,(3.1±0.4)points]at 4,12 and 24 h after operation than nalbuphine group[(2.7±0.3)points,(3.1±0.2)points,(3.6±0.3)points],activity VAS score[(2.8±0.4)points,(3.3±0.4)points,(3.5±0.3)points]than nalbuphine group[(3.4±0.2)points,(3.6±0.2)points,(3.7±0.4)points],and lower resting Ramsay sedation score[(2.0±0.3)points,(2.3±0.3)points,(3.0±0.4)points]than nalbuphine group[(2.5±0.5)points,(2.6±0.4)points,(3.3±0.3)points],The Ramsay sedation score of activity[(2.8±0.3)points,(3.3±0.3)points,(3.4±0.3)points]was lower than that of nalbuphine group[(3.2±0.2)points,(3.6±0.2)points,(3.7±0.4)points],the VAS score of maximum pain at 1,2 and 3 d after surgery[(3.7±0.4)points,(3.5±0.6)points,(2.9±0.4)points]was lower than that of nalbuphine group[(3.9±0.3)points,(3.8±0.4)points,(3.3±0.5)points],and the average daily dosage of icoxib during hospitalization(60 mg)was less than that of nalbuphine group(100 mg),The patient satisfaction score[(9.5±0.4)points]was higher than that of nalbuphine group[(8.9±0.7)points],and the differences were statistically significant(P<0.05).The IL-6[(150.33±19.16)pg/ml],TNF-α[(38.21±4.78)pg/ml]and CRP levels[(6.74±0.28)mg/ml]in the combined anesthesia group were lower than those in the nalbuphine group[(269.85±27.76)pg/ml,(61.95±6.72)pg/ml,(7.82±0.51)mg/ml],and the differences were statistically significant(P<0.05).The total incidence of adverse reactions in the combined anesthesia group[30.4%(14/46)]was lower than that in the nalbuphine group[58.7%(27/46)],and the difference was statistically significant(P<0.05).Conclusions The analgesic effect and the influence on inflammatory factors of nalbuphine combined with dexmedetomidine in patient controlled analgesia of LU are better than those of nalbuphine alone.
作者
孙鹏
栾慧
尹青梅
王伟民
蓝海宏
Sun Peng;Luan Hui;Yin Qingmei;Wang Weimin;Lan Haihong(Department of Anesthesiology,Laiyang Central Hospital,Yantai 265200,China;Department of Radiology,Laiyang Central Hospital,Yantai 265200,China;Department of Pain,Yantai Laiyang Central Hospital,Yantai 265200,China;Department of Urology,Laiyang Central Hospital,Yantai 265200,China)
出处
《中国临床实用医学》
2023年第3期48-53,共6页
China Clinical Practical Medicine
基金
烟台市科技计划项目(2022YD)。
关键词
纳布啡
右美托咪定
腹腔镜输尿管取石术
术后镇痛
Nalbuphine
Dexmedetomidine
Laparoscopic ureterolithotomy
Postoperative analgesia
作者简介
通信作者:栾慧,Email:llllulululu@yeah.net。
