盐酸纳美芬改善老年病人胃癌术后苏醒和镇痛的效果观察

目的:探讨盐酸纳美芬改善老年病人胃癌手术后苏醒和镇痛的效果。方法:选择拟行手术治疗的老年胃癌病人90例，随机分为对照组、纳美芬低剂量组和纳美芬高剂量组，各30例。对照组手术结束时静脉注入0.9%氯化钠注射液2 mL，出手术室时连接PCIA镇痛泵（酒石酸布托啡诺0.2 mg/kg）；低、高剂量组分别于手术结束时静脉注入0.25、0.50 μg/kg盐酸纳美芬，出手术室时连接PCIA镇痛泵（酒石酸布托啡诺0.2 mg/kg+盐酸纳美芬2 μg/kg）。比较3组病人术后自主呼吸恢复时间、睁眼时间、拔管时间、苏醒期不同时间点Narcotrend值、拔管后精神状态（意识障碍、躁动、谵妄），并比较3组病人术后1、2、6、12、24、48 h的疼痛视觉模拟（VAS）评分、Ramsay镇静评分和恶心呕吐（PONV）评分。结果:高剂量组病人自主呼吸恢复时间、睁眼时间和拔管时间均明显少于低剂量组和对照组（P<0.01），低剂量组亦均明显少于对照组（P<0.01）。3组病人给药时Narcotrend值差异无统计学意义（P>0.05）；给药后5、10、15 min，高剂量组Narcotrend值均明显高于低剂量组和对照组（P<0.01）；给药后20 min，高、低剂量组Narcotrend值均明显高于对照组（P<0.01）。3组意识障碍和躁动/谵妄情况间差异均无统计学意义（P>0.05）。术后1 h和48 h，高剂量组VAS评分均明显低于对照组（P<0.01）；术后1~48 h，高剂量组Ramsay镇静评分和PONV评分均明显低于对照组（P<0.01）。结论:纳美芬可有效改善老年胃癌病人术后麻醉苏醒效果，维持良好的术后镇痛，并可减轻阿片类药物不良反应，值得临床推广。

Effect of nalmefene hydrochloride in improving the postoperative resuscitation and analgesia in elderly patients with gastric cancer

Objective:To investigate the effects of nalmefene hydrochloride in improving the postoperative resuscitation and analgesia in elderly patients with gastric cancer.Methods:Ninety elderly gastric cancer patients scheduled by operation were randomly divided into the control group,low-dose nalmefene group and high-dose nalmefene group(30 cases each group).The control group was intravenously injected with 2 mL normal saline at the end of surgery,and a PCIA analgesia pump(filling with 0.2 mg/kg butorphanol tartrate) were connected.The low-dose and nalmefene high-dose groups were intravenously injected with 0.25 and 0.50 μg/kg of nalmefene hydrochloride at the end of surgery,and a PCIA analgesia pump(filling with 0.2 mg/kg butorphanol tartrate and 2 μg/kg of nalmefene hydrochloride) were connected.The postoperative spontaneous breathing recovery time,eye opening time,extubation time,Narcotrend value and mental state(including conscious disturbance,agitation,and delirium) of patients between three groups were compared,and the VAS score,ramsay sedation score and postoperative nausea and vomiting(PONV) score between three groups were compared after 1,2,6,12,24 and 48 hours of operation.Results:The recovery time of spontaneous breathing,eye opening time and extubation time in high-dose group were significantly lower than those in low-dose group and control group(P<0.01),and which in low-dose group was significantly less than that in control group(P<0.01).The differences of the Narcotrend value between three groups at administration were not statistically significant(P>0.05),the Narcotrend values in high-dose group after 5,10 and 15 minutes of administration were significantly higher than those in low-dose group and control group(P<0.01),and the Narcotrend values in low-dose and high-dose groups after 20 minutes of administration were significantly higher than that in control group(P<0.01).The differences of the conscious disturbance,agitation,and delirium between three groups were not statistically significant(P>0.05).The VAS scores in high-dose group after 1 h and 48 h of operation were significantly lower than that in control group(P<0.01).The scores of Ramsay sedation and PONV in high-dose group after 1 h to 48 h of operation were significantly lower than that in control group(P<0.01).Conclusions:Nalmefene hydrochloride can effectively improve the postoperative recovery,and allivate the adverse reactions of opioid drug,which is worthy of promotion in clinic.