等效剂量法评价舒芬太尼复合纳布啡用于妇科腹腔镜手术后自控镇痛效果

目的 采用等效剂量法评价舒芬太尼复合纳布啡用于腹腔镜下子宫全切患者术后静脉自控镇痛（PCIA）的效果。方法 选择拟行腹腔镜子宫全切患者180例。美国麻醉医师协会（ASA）分级Ⅰ~Ⅱ级，体质量指数（BMI）18~25 kg/m2。采用随机数字表法分为3组（n=60）：舒芬太尼组（S组）、纳布啡组（N组）和舒芬太尼复合纳布啡组（NS组）。手术结束即刻给予PCIA，PCIA的总量为100 mL，负荷剂量为5 mL，自控追加剂量为0.5 mL，锁定间隔时间15min，持续输注量2 mL/h。S组PCIA舒芬太尼2 μg/kg+托烷司琼10 mg +生理盐水配至100 mL。N组PCIA纳布啡2mg/kg+托烷司琼10 mg+生理盐水配至100 mL。NS组PCIA舒芬太尼1 μg/kg+纳布啡1 mg/kg+托烷司琼10 mg配至100 mL。比较3组患者手术结束后4 h（T1）、8 h（T2）、12 h（T3）、24 h（T4）的VAS评分和Ramsay镇静评分，术后镇痛泵使用完毕时PCIA有效按压次数，镇痛药物补救总量，止吐药追加总量以及不良反应的发生率。结果 3组患者一般情况及各个时间点VAS评分比较差异无统计学意义（P＞0.05）。PCIA按压次数S组大于N组（P＜0.05），N组和NS组比较差异无统计学意义（P＞0.05）。N组Ramsay镇静评分大于S组和NS组（P＜0.05），S组和NS组比较差异无统计学意义（P＞0.05）。S组恶心呕吐发生率高于N组（P＜0.016 7），S组、N组与NS组比较差异无统计学意义（P＞0.016 7）。S组托烷司琼追加剂量大于N组和NS组（P＜0.05），N组和NS组比较差异无统计学意义（P＞0.05）。3组均未追加补救止痛药物，均未发生呼吸抑制和皮肤瘙痒。结论 纳布啡复合舒芬太尼用于腹腔镜子宫全切患者PCIA，既可避免大剂量纳布啡产生的过度镇静效果，又可减少舒芬太尼用量，从而降低恶心呕吐发生率，且镇痛效果较好，具有良好的有效性和安全性。

Effects of sufentanil combined with nalbuphine on postoperative patient-controlled analgesiaafter gynecologic laparoscopic surgery

Objective To observe the efficacy of patient-controlled intravenous analgesia (PCIA) using sufentanilsupplement with nalbuphine on patients underwent laparoscopic total hysterectomy. Methods A total of 180 patients, ageranged from 18 to 65 year, BMI 18-25 kg/m2, ASA physical status Ⅰ-Ⅱ, undergoing laparoscopic total hysterectomy wereselected. They were randomly divided into 3 groups (n=60 for each group): sufentanil group (group S), nalbuphine group(group N) and sufentanil supplement with nalbuphine group (group NS). PCIA pump was given at the end of the operationwith 5 mL bonus loading. The total amount of PCIA was 100 mL, and which was programmed to deliver 0.5 mL each timewith a lockout interval of 15min and the background infusion amount of 2 mL/h. In the group S, PCIA regiment composed ofsufentanil 2 μg/kg and 10mg tropisetron in 100 mL of normal saline. In the group N, PCIA regiment composed of nalbuphine2 mg/kg and 10 mg tropisetron in 100 mL of normal saline. In the group NS, PCIA regiment composed of sufentanil 1 mg/kg,nalbuphine 1 mg/kg and 10 mg tropisetron in 100 mL of normal saline. The VAS score and Ramsay score were recorded afterthe operation, and the number of effective compression of PCIA was also recorded. Adverse reactions were documented indetails. Results There was no significant difference in general condition between the three groups (P＞0.05). There was no significant difference in VAS scores between the 3 groups at all time points (P＞0.05). PCIA press times were significantlymore in group S than those of group N (P＜0.05). But there was no significant difference between group S and group NS (P＞0.05). Ramsay scores were higher in group N than those in group S and group NS (P＜0.05). But there was no significantdifference between group S and group NS (P＞0.05). The incidence of nausea and vomiting were higher in group S than thosein group N (P＜0.016 7), but there was no statistical difference in group NS compared with that of group S and group N (P＞0.016 7). The additional dose of tropisetron was higher in group S than that in group N and group NS (P＜0.05), but there wasno statistical difference between group N and group NS (P＞0.05). Conclusion Nalbuphine supplement sufentanil hasgreat efficiency for postoperative patient-controlled intravenous analgesia in laparoscopic hysterectomy. It not only can avoidthe excessive sedative effect produced by large doses of nalbuphine, but also reduces the amount of sufentanil, thus reducingthe incidence of nausea and vomiting, and the analgesic effect is satisfaction.