纳布啡多模式镇痛在胸腔镜肺叶切除术中的镇痛效果  

Analgesic efficacy of nalbuphine in postoperative thoracoscopic lobectomy

作　　者：高晨 李涛 章敏[2] 周玲[2] 疏树华[2] 柴小青 谢言虎 GAO Chen;LI Tao;ZHANG Min;ZHOU Ling;SHU Shuhua;CHAI Xiaoqing;XIE Yanhu(Graduate School,Wannan Medical College,Wuhu 241002,China)

机构地区：[1]皖南医学院研究生学院,安徽芜湖241002 [2]中国科学技术大学附属第一医院麻醉科,安徽合肥230001

出　　处：《皖南医学院学报》2018年第2期189-192,共4页Journal of Wannan Medical College

摘　　要：目的:探讨纳布啡多模式镇痛在胸腔镜肺叶切除术中的镇痛效果。方法:选取择期行胸腔镜下单侧肺叶切除术患者60例,随机分为纳布啡组(N组)、对照组(C组)各30例。麻醉诱导前,N组静脉注射纳布啡0.2 mg/kg,术毕前切口局部浸润镇痛,术后纳布啡自控镇痛;C组麻醉诱导前静脉注射硫酸吗啡0.2 mg/kg,术毕前切口局部浸润镇痛,术后吗啡自控镇痛。分别记录术前(T0)、术后2 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)视觉模拟(VAS)评分,术后最高镇静(Ramsay)评分、首次镇痛按压时间、无效按压次数、术后并发症及胸引管拔出时间、住院时间。检测T1~T4时刻血清白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)浓度。结果:两组患者术后各时点VAS评分、最高Ramsay评分、首次镇痛按压时间、无效按压次数差异无统计学意义(P>0.05)。与C组比较,N组术后并发症降低(P<0.05);胸引管拔出时间及住院时间缩短(P<0.05);T1~T4时刻TNF-α和IL-6浓度降低,IL-10浓度升高(P<0.05)。结论:纳布啡可调节免疫应答,减少炎性因子产生,缓解术后早期疼痛,减少并发症,缩短住院时间。Objective:To investigate the postoperative analgesic effects nalbuphine on patients undergoing thoracoscopic lobectomy.Methods:Sixty patients undergoing elective thoracoscopic unilateral lobectomy were equally randomized into nalbuphine group(group N)and control group(group C).Before anesthesia induction,patients in group N received intravenous 0.2mg/kg of nalbuphine,local wound infiltration analgesia before completion of surgery and patient-controlled analgesia(PCA)with nalbuphine following surgery.Patients in group C were given intravenous 0.2mg/kg of morphine before induction,local incision infiltration with morphine before completion of the surgery and PCA after operation.Data maintained in the two groups included VAS scoring before surgery(T0),2 h(T1),6 h(T2),12 h(T3),24 h(T4)and 48 h(T5)after surgery,respectively,the highest Ramsay sedation scoring,the first pressing time of PCA,the number of unsuccessfully delivered dose,postoperative complications and the time to remove chest drainage tube,and length of hospital stay.Plasma levels of interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)were measured at the time point from T1 to T4 in the two groups.Results:The two groups were not significantly different in VAS scores at each time point,maximal Ramsay scoring,the first pressing time of PCA and the number of failed dose delivery(P>0.05).Patients in group N had lower postoperative complications,earlier removal of the chest tube,shortened postoperative hospital stay,decreased IL-6 and TNF-αlevels,yet increased IL-10 level at between T1 and T4 as compared to group C(all P<0.05).Conclusion:Nalbuphine can effectively reduce inflammatory reaction,alleviate postoperative pain,reduce complications and shorten postoperative hospital stay for patients undergoing thoracoscopic lobectomy.

关 键 词：纳布啡 多模式镇痛 胸腔镜 

分 类 号：R614[医药卫生—麻醉学] R655.3[医药卫生—外科学]