咪达唑仑联合不同剂量盐酸纳布啡用于 重度肥胖患者无痛胃镜检查的效果

〔摘 要〕 目的：探讨咪达唑仑联合不同剂量盐酸纳布啡用于重度肥胖患者无痛胃镜检查的效果。 方法：选择南昌市 第五医院 2018 年 1 月至 2020 年 7 月期间接受无痛胃镜检查的 126 例重度肥胖患者，按随机数字表法分为对照组和观察 组，各 63 例。观察组应用 2.5 mg 纳布啡复合咪达唑仑；对照组应用 5 mg 纳布啡复合咪达唑仑。比较两组患者的镇痛与镇 静情况、苏醒时间、体动与并发症。 结果：两组患者在苏醒后 5 min 的视觉模拟评分法（VAS）评分、麻醉诱导后 2 min 的 Ramsay 镇静评分比较，差异无统计学意义（P ＞ 0.05）；在苏醒后 30 min 两组患者的 VAS 评分较苏醒后 5 min 下降，差 异具有统计学意义（P ＜ 0.05）；但苏醒后 30 min 两组患者的 VAS 评分比较，差异无统计学意义（P ＞ 0.05）。内镜入喉时， 两组患者的的 Ramsay 镇静评分均较麻醉诱导后 2 min 升高，差异具有统计学意义（P ＜ 0.05）；但内镜入喉时两组患者的 Ramsay 镇静评分比较，差异无统计学意义（P ＞ 0.05）。观察组患者的完全苏醒时间为（5.03 ± 1.04）min，短于对照组的 （5.50 ± 1.20）min，差异具有统计学意义（P ＜ 0.05）。两组患者均无严重体动发生，且一般体动的发生率比较，差异无 统计学意义（P ＞ 0.05）；观察组患者的并发症发生率为 7.94 %，低于对照组的 20.63 %，差异具有统计学意义（P ＜ 0.05）。 结论：重度肥胖患者行无痛胃镜检查应用 2.5 mg 或 5 mg 的盐酸纳布啡复合咪达唑仑均可有效镇静镇痛，体动发生情况少， 但低剂量的盐酸纳布啡可减少并发症的发生，且利于患者苏醒。     

纳布啡复合丙泊酚对腹腔镜腹股沟疝修补术的麻醉效果

目的观察纳布啡复合丙泊酚对腹腔镜腹股沟疝修补术的麻醉效果，并分析其对患者应激、炎症因子的影响。 方法选择2015年10月至2018年10月，广西壮族自治区人民医院行腹腔镜腹股沟疝修补术的182例患者作为研究对象，按随机数字法将其分为2组。研究组患者91例，行钠布啡复合丙泊酚静脉麻醉；对照组患者91例，行芬太尼复合丙泊酚静脉麻醉。对比2组患者的麻醉效果、麻醉起效时间、术后清醒时间以及术后1 d疼痛情况，并通过促甲状腺激素（TSH）与皮质醇（Cor）水平观察患者应激反应，对比炎症因子超敏C反应蛋白（hs-CRP）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）的变化情况。 结果2组患者手术麻醉起效时间与术后清醒时间比较，差异无统计学意义（P>0.05）；研究组的术后1 d疼痛评分显著低于对照组，差异有统计学意义（P<0.05）。2组患者术前1 d的hs-CRP、IL-6、TNF-α表达水平比较，差异无统计学意义（P均>0.05）；术后1 d研究组的hs-CRP、IL-6、TNF-α表达水平均显著低于对照组，差异有统计学意义（P<0.05）。2组患者术前1 d的TSH、Cor表达水平比较，差异无统计学意义（P均>0.05）；术后1 d的TSH表达水平比较，差异无统计学意义（P>0.05），术后1d研究组的Cor表达水平均显著低于对照组，差异有统计学意义（P<0.05）。 结论纳布啡复合丙泊酚作为腹腔镜腹股沟疝修补术麻醉方式能取得较好的麻醉效果，并且能减轻患者术后疼痛，减少应激反应与炎症反应，可作为腹腔镜腹股沟修补术的优选麻醉方式。     

纳布啡和地佐辛分别复合丙泊酚用于无痛人流术的临床观察

目的探究纳布啡和地佐辛分别复合丙泊酚用于无痛人流术的应用效果。方法选取2019年4月至2019年10月南昌市第三医院及南昌市第五医院接收的行无痛人流术者120例为研究对象,以整群随机化方式分为3组,即5 mg地佐辛复合丙泊酚组(D组),0.1 mg/kg纳布啡复合丙泊酚组(N1组)和0.15 mg/kg纳布啡复合丙泊酚组(N2组),各40例。观察3组患者的生命体征相关指标、疼痛评分、术后眩晕及恶心发生率。结果D组呼吸频率低于N1组、N2组,差异有统计学意义(P<0.05);D组患者疼痛评分均高于N1组、N2组,差异有统计学意义(P<0.05);D组患者术后眩晕、恶心发生率分别为22.50%、27.50%,均高于N1组的5.00%、7.50%,N2组的7.50%、10.00%,差异有统计学意义(P<0.05)。结论与地佐辛复合丙泊酚麻醉比较,对行无痛人流术患者予以纳布啡复合丙泊酚麻醉,能有效降低无痛人流术患者术中呼吸抑制、术后疼痛和眩晕恶心发生率,降低患者不适感。     

纳布啡联合右美托咪定用于无痛超声支气管镜检查的价值研究

目的 探讨纳布啡联合右美托咪定用于无痛超声支气管镜检查的临床价值。方法 选取本院2018年6月至2020年6月无痛超声支气管镜检查患者80例,以双盲随机抽样法分组,每组各40例,对照组采用芬太尼+麻醉,观察组采用纳布啡联合右美托咪定麻醉,比较两组不同时段HR、MAP、Ramsay评分、2%利多卡因冲洗量、术中呛咳3次发生率、清醒时间及不良反应发生率。结果 观察组T1、T2、T3HR[(93.62±6.62)次/min、(85.62±4.16)次/min、(82.64±3.16)次/min]、MAP[(112.62±7.16)mmHg、(85.21±4.69)mmHg、(83.26±2.64)mmHg]与对照组比较,差异无统计学意义(P0.05);T2、T3时观察组、对照组Ramsay评分[(1.41±0.25)分、(1.33±0.20)分、(1.38±0.26)分、(1.31±0.22)分]比较,差异无统计学意义(P0.05)。观察组T4、T5组HR[(73.26±2.16)次/min、(78.26±3.61)次/min]、MAP[(81.26±1.34)mmHg、(83.26±3.66)mmHg]均低于对照组,观察组T4、T5Ramsay评分[(1.22±0.16)分、(1.24±0.13)分]比对照组[(1.49±0.62)分、(1.55±0.46)分]低(P0.05)。观察组术中呛咳3次发生率(2.50%)、不良反应发生率(2.50%)均低于对照组(17.50%、20.00%),观察组2%利多卡因冲洗量为(15.26±1.62)mL,低于对照组的(25.69±3.62)m L;观察组清醒时间为(12.26±1.66)min,低于对照组的(21.38±4.14)min,差异均有统计学意义(P0.05)。结论 纳布啡联合右美托咪定应用于无痛超声支气管镜检查中,可维持HR及MAP稳定,减少2%利多卡因冲洗量及不良反应,缩短患者清醒时间,值得借鉴。     

Dose-dependent attenuation of intravenous nalbuphine on epidural morphine-induced pruritus and analgesia after cesarean delivery

Epidural morphine in patient-controlled analgesia regimens controls postoperative pain well but easily induces pruritus and other epidural morphine-related side effects. With 90 pregnant American Society of Anesthesiologists physical status II females scheduled for elective cesarean delivery, the present study was designed to evaluate the efficacy and safety profile of patient-controlled antipruritus (PCP) use of intravenous nalbuphine-based regimens for attenuation of postoperative pruritus and related side effects in combination with epidural morphine patient-controlled analgesia with regard to the quality of postoperative pain management. Patients were randomly assigned to two nalbuphine groups (5 μg/kg/hour, Group N5 or 10 μg/kg/hour, Group N10) and bolus dose of 1.6 μg/kg for PCP or the control (normal saline) group. Comparable visual analog scale scores for rest pain at each measured time interval among the three groups demonstrated that adequate pain relief was offered; however, the cumulative dose of nalbuphine administered to the patients in Group N10 attenuated the analgesic effect of epidural morphine in moving pain at POh24 only. Fewer episodes and milder severity of pruritus were observed in patients in Groups N5 and N10 at all postoperative time intervals. Epidural morphine provided good postoperative pain relief but with incommodious side effects. In addition, intravenous nalbuphine not only attenuated the incidence of pruritus but also decreased total morphine consumption. In conclusion, intravenous administration of low-dose nalbuphine (5 μg/kg/hour) for PCP maintained analgesia produced by epidural morphine and offered low pruritus incidence.     

Comparative study between dexmedetomidine/nalbuphine and midazolam/nalbuphine in monitored anesthesia care during ear surgery

BackgroundMonitored anesthesia care (MAC) is the practice of administrating local anesthesia in combination with IV sedatives, anxiolytics and/or analgesic drugs during certain surgical procedures. Most of ear surgeries can be done under monitored anesthesia care.MethodologyThis is a randomized, double blind, prospective study and 100 patients undergoing ear surgery under MAC were divided into two groups of 50 patients each. The patients in group (D) received dexmedetomidine 1 μg/kg IV over 10 min followed by 0.7 μg/kg/h + nalbuphine 100 μg/kg IV and in group (M) received midazolam 20 μg/kg IV followed by 20 μg/kg/h + nalbuphine 100 μg/kg over 10 min. Assessment of sedation by Ramsay sedation score, requirement of intraoperative rescue sedation, intraoperative VAS, intraoperative rescue analgesia, intraoperative hemodynamics, intraoperative bleeding, intraoperative complications, postoperative visual analogue score and postoperative rescue analgesia requirement, time to achieve full recovery and satisfaction scores of patients and surgeon were recorded.ResultsGroup (D) showed more sedation by Ramsay sedation score than the midazolam (M) group. Fifty percent in group (M) needed more rescue sedation than 26% in group (D) (p < 0.05). Intraoperative VAS was significantly higher in group (M) than in group (D) that led to the use of more rescue analgesia in 60% of group (M). Intraoperative heart rate and mean blood pressure were significantly lower in group (D) than in group (M) (p < 0.05). There was no statistical difference between the two groups as regards respiratory rate or SpO₂. Intraoperative bleeding is less significantly less in group (D). Intraoperative hypotension was significantly higher in group (D) (30%) than in group (M) (20%). Bradycardia was insignificantly higher in group (D). As regards postoperative VAS, group (D) was significantly lower than group (M). This led to the use of more rescue analgesia in 94% of group (M). There was no statistically significant difference between the two groups as regards recovery time. Patient’s satisfaction was significantly higher in group (D) (80%) compared with group (M) (60%) (p >0.05). The same as regards doctor’s satisfaction where satisfaction was significantly higher in group (D) (76%) than in group (M) (54%).ConclusionWe concluded that the combination of dexmedetomidine/nalbuphine is a better alternative to midazolam/nalbuphine in MAC since it provides analgesia, amnesia and sedation with better intraoperative and postoperative patient satisfaction with better surgical field exposure.     

纳布啡联合利多卡因切口浸润多模式镇痛对小儿外科单孔腹腔镜手术患者全麻苏醒期躁动的影响

目的 探讨纳布啡联合利多卡因切口浸润多模式镇痛对接受单孔腹腔镜手术患儿全麻苏醒期躁动的影响。方法 选取2018 年12 月～2019 年12 月在牡丹江医学院附属红旗医院行单孔腹腔镜手术的全麻患儿150 例,随机分成3 组,每组50 例。纳布啡组（N 组）于手术结束前15 min 静注0.2 mg/kg 纳布啡,关闭腹膜后在切口推注生理盐水10 mL;利多卡因组（L 组）于术毕缝皮前在切口推注0.5%的利多卡因10 mL;纳布啡+利多卡因组（N+L 组）于手术结束前15 min 静注0.2 mg/kg 纳布啡,术毕缝皮前在切口推注0.5%的利多卡因10 mL。记录患儿在PACU的PAED 躁动评分、拔管后的Ramsay 镇静评分及VAS 疼痛评分;记录入室时（T0）、停药时（T1）、拔管时（T2）、拔管后10 min（T3）患儿MAP 和HR 的变化;记录患儿的苏醒时间和拔管时间及不良反应。结果 N 组和L 组的PAED躁动评分分数和VAS 疼痛评分分数均高于N+L 组,差异有统计学意义（P＜0.05）;N 组和N+L 组的Ramsay 镇静评分均高于L 组,差异有统计学意义（P＜0.05）;在T0 和T1 时刻,N 组、L 组和N+L 组患儿的MAP 和HR 的数值比较,差异均无统计学意义（P＞0.05）;在T2 和T3 时刻,N 组和L 组的MAP 和HR 的数值明显高于N+L 组,差异有统计学意义（P＜0.05）;在N 组和L 组中,T0、T1、T2 和T3 四个时刻的MAP 和HR 的数值比较,差异有统计学意义（P＜0.05）;在N+L 组中,T1 和T3 时刻的MAP 和HR 的数值比较,T1 和T2 时刻的HR 的数值比较,差异均无统计学意义（P＞0.05）,其他时刻的MAP 和HR 的数值比较,差异均有统计学意义（P＜0.05）;三组患儿的苏醒时间和拔管时间比较,差异均无统计学意义（P＞0.05）;三组患儿在拔管后均未发生恶心、呕吐、嗜睡、喉痉挛、皮肤瘙痒和呼吸循环抑制等不良反应。结论 纳布啡联合利多卡因镇痛方法效果确切,可有效抑制患儿全麻苏醒期躁动的发生,并对其血流动力学影响小、不良反应少、不会明显延长苏醒时间和拔管时间。     

Use of the mixed agonist–antagonist nalbuphine in opioid based analgesia

Opiate analgesics provide effective pain relief and are widely used for control of mild to severe pain. The well-known side effects of the mu-agonist opioids, including pruritis, nausea/emesis, constipation, urinary retention, respiratory depression, excessive sedation, and the development of tolerance and dependence, are occasionally problematic. Here we review use of the mixed opioid agonist–antagonist nalbuphine in opioid analgesia with a view to its potential advantages. Used as the sole opioid analgesic, it can satisfactorily cover mild to moderate pain with a low incidence of the common opioid side effects. With care, it can be used concurrently with the more commonly employed mu-opioid agonists (e.g. morphine, hydromorphone, fentanyl), yielding good analgesia while simultaneously decreasing the incidence and severity of mu-agonist side effects. This paper provides information sufficient to enable the practitioner to determine whether nalbuphine might be a useful addition to his/her pharmacopoeia.     

腹腔镜肝切除术治疗原发性肝癌患者应用氢吗啡酮联合纳布啡静脉自控镇痛控制疼痛作用研究*

目的 探讨腹腔镜肝切除术(LH)治疗原发性肝癌(PLC)患者应用氢吗啡酮联合纳布啡静脉自控镇痛(PCIA)控制疼痛的效果。方法 2018年1月～2021年1月我院收治的PLC患者104例,随机分为对照组52例和观察组52例,两组患者均接受LH手术,在对照组,给予舒芬太尼联合纳布啡用于术后PCIA,而在观察组给予氢吗啡酮联合纳布啡用于术后PICA。采用疼痛视觉模拟评分(VAS)评价术后疼痛程度,使用流式细胞仪检测外周血T细胞亚群CD3⁺细胞、CD4⁺细胞、CD8⁺细胞和NK细胞百分比。结果 在术后24 h,观察组静态VAS和动态VAS分别为(2.5±0.8)分和(3.7±1.2)分,显著低于对照组【分别为(4.3±1.2)分和(5.8±1.7),P＜0.05】,在术后72 h,静态VAS和动态VAS分别为(1.1±0.4)分和(3.2±0.9)分,显著低于对照组【分别为(2.6±0.7)分和(5.1±1.3),P＜0.05】;术后,两组肝功能指标变化无显著性差异(P＞0.05);在术后7 d,观察组外周血CD3⁺细胞、CD4⁺细胞、CD8⁺细胞和NK细胞百分比分别为(76.3±7.5)%、(36.8±4.9)%、(32.5±3.2)%和(16.3±2.9)%,与对照组【分别为(75.2±7.4)%、(37.6±4.4)%、(31.2±3.4)%和(17.4±2.6)%】比,差异无统计学意义(P＞0.05)。结论 氢吗啡酮联合纳布啡用于LH后PCIA能够有效减轻患者疼痛程度。     

纳布啡对瑞芬太尼诱发患者术后痛觉过敏的预防效果分析

目的探讨纳布啡对瑞芬太尼诱发患者术后痛觉过敏的预防效果。方法选择2018年1月至2019年3月在我院拟行妇科手术患者120例,随机分为A组、B组和C组,各40例。麻醉前5 min,A、B、C组分别静脉注射3 mL生理盐水、40 mg帕瑞昔布钠、0.3 mg/kg纳布啡。比较三组患者苏醒后疼痛程度、镇静情况及不良反应发生情况。结果C组苏醒后0.5 h、1 h VAS评分分别为(2.12±0.33)分、(2.04±0.27)分,均低于A组、B组(P<0.05)。C组苏醒后0.5 h、1 h Ramsay镇静评分分别为(2.79±0.58)分、(2.75±0.74)分,均高于A组、B组(P<0.05)。C组的恶心呕吐、寒颤发生率均低于A组、B组(P<0.05)。结论纳布啡可有效预防瑞芬太尼诱发的术后痛觉过敏,增强镇静效果,避免麻醉恢复期出现躁动,减少不良反应,提高患者耐受性。