不同剂量纳布啡复合舒芬太尼用于腹腔镜全子宫切除术后患者自控静脉镇痛的效果

目的观察不同剂量纳布啡复合舒芬太尼在腹腔镜全子宫切除术后PCIA中的效果。方法选择本院择期行腹腔镜全子宫手术的患者120例,年龄40~60岁,体重45~70 kg,ASAⅠ或Ⅱ级,采用随机数字表法随机分为四组,每组30例。术后均采用PCIA,S组给予舒芬太尼2.0μg/kg+格拉司琼2 mg+生理盐水至120 ml,SN1、SN2、SN3组分别给予0.2、0.4和0.8mg/kg纳布啡+舒芬太尼2.0μg/kg+格拉司琼2 mg+生理盐水至120 ml。记录患者术后1、4、8、12、24、48 h Ramsay镇静评分、PCIA有效按压次数及补救镇痛和术后48 h内不良反应的发生情况。结果术后8、12、24、48 h,与S组比较,SN2组和SN3组镇痛泵有效按压次数明显减少,Ramsay镇静评分明显升高(P<0.05);与SN1组比较,SN2组和SN3组镇痛泵有效按压次数明显减少,Ramsay镇静评分明显升高(P<0.05);与SN2组比较,SN3组Ramsay镇静评分明显升高(P<0.05)。S组和SN1组补救镇痛率明显高于SN2组和SN3组(P<0.05)。术后48 h内SN2组和SN3组恶心、呕吐发生率明显低于S组和SN1组,SN3组嗜睡发生率明显高于SN2组(P<0.05)。结论纳布啡0.4mg/kg复合舒芬太尼2.0μg/kg用于腹腔镜全子宫镇痛效果满意,不良反应发生率低。

Effect of different dose of nalbuphine combined with sufentanil for patient-controlled intravenous analgesia after laparoscopic hysterectomy

Objective To observe the effects of different doses of nalbuphine combined with sufentanil in patient-controlled intravenous analgesia(PCIA)after laparoscopic hysterectomy,and to explore the best compatible dose of nalbuphine in PCIA.Methods A total of 120 patients selected for laparoscopic hysterectomy,aged 40-60 years,weighing 45-70 kg,falling into ASA physiacl statusⅠorⅡ,were randomly divided into four groups by using random number table:group S,group SN1,group SN2 and group SN3,with 30 cases in each group.PCIA was conducted in the four groups.Group S was given sufentanil 2.0μg/kg+granisetron 2 mg+normal saline to 120 ml,groups SN1,SN2 and SN3 were given nabuphine 0.2,0.4 and 0.8 mg/kg+sufentanil 2.0μg/kg+granisetron 2 mg+normal saline to 120 ml.Ramsay sedation score,effective pressing times of PCIA,additional analgesia and adverse reactions within 48 h after operation were recorded.Results Compared with group S,the effective pressing times of PCIA in groups SN2 and SN3 decreased significantly while the sedation scores were higher at 8,12,24 and 48 h after surgery(P<0.05).Compared with group SN1,the effective pressing times of PCIA in groups SN2 and SN3 decreased significantly while the sedation scores were higher at 8,12,24 and 48 h after surgery(P<0.05).Compared with group SN2,the sedation score in group SN3 were higher at 8,12,24 and 48 h after surgery(P<0.05).The analgesic rates of groups S and SN1 were significantly higher than those in groups SN2 and SN3(P<0.05).The incidence of nausea and vomiting in groups SN2 and SN3 were higher compared with groups S and SN1(P<0.05).The incidence of somnolence in group SN3 was higher than that in group SN2(P<0.05).Conclusion Nalbuphine 0.4 mg/kg combined with sufentanil 2.0μg/kg for laparoscopic whole uterus analgesia is satisfactory,and the incidence of adverse reactions is less.