纳布啡联合舒芬太尼对西宁地区老年髋关节置换术患者围术期应激反应和苏醒期躁动的影响  

Effects of nalbuphine combined with sufentanil on perioperative stress response and emergence agitation in elderly patients undergoing hip arthroplasty in Xining

作　　者：何旭秀 曲宁[1] 范文娴 HE Xu-xiu;QU Ning;FAN Wen-xian(Department of Anesthesiology,Qinghai Provincial Hospital of Traditional Chinese Medicine,Xining 810000,Qinghai,China;Department of Surgical Anesthesia,Qinghai Provincial Hospital of Traditional Chinese Medicine,Xining 810000,Qinghai,China)

机构地区：[1]青海省中医院麻醉科,青海西宁810000 [2]青海省中医院手术麻醉科,青海西宁810000

出　　处：《川北医学院学报》2022年第1期67-70,共4页Journal of North Sichuan Medical College

基　　金：青海省卫计委指导性科研项目(2018-wjzdx-61)。

摘　　要：目的:探究纳布啡联合舒芬太尼对西宁地区老年髋关节置换术患者围术期应激反应和苏醒期躁动的影响。方法:回顾性分析60例老年髋关节置换术患者的临床资料,根据麻醉方式不同分为观察组(n=30)和对照组(n=30)。两组麻醉诱导均采用舒芬太尼,观察组给予于麻醉诱导前静脉注射纳布啡,对照组给予等量生理盐水。比较两组入室(T0)、插管即刻(T1)、拔管即刻(T2)的收缩压(SBP)、舒张压(DBP)、心率(HR)、皮质醇(Cor)和血糖(Glu);记录两组的自主呼吸恢复时间、定向力恢复时间、拔管时间、躁动评分、Ramasay评分及不良反应发生情况,并比较两组不同时间的疼痛评分(VAS)及认知功能(MMSE评分)变化。结果:观察组在T1、T2时的SBP、DBP、HR、Glu、Cor均低于对照组,差异有统计学意义(P<0.05);观察组自主呼吸恢复时间、定向力恢复时间、拔管时间均短于对照组(P<0.05);观察组拔管后5 min躁动评分低于对照组(P<0.05),Ramasay评分高于对照组(P<0.05);术后2、12、24 h,观察组的VAS评分均低于对照组(P<0.05);术后1、3 d,观察组的MMSE评分均高于对照组(P<0.05);观察组术后48 h的不良反应发生率为6.67%,低于对照组的26.67%(P<0.05)。结论:纳布啡联合舒芬太尼用于老年患者行髋关节置换术时,可于术中维持较好的麻醉深度及血流动力学稳定,降低应激反应、苏醒期躁动,具有较好的镇痛镇静效果,且对患者认知功能影响较小,安全性较高。Objective:To explore the effects of nalbuphine combined with sufentanil on perioperative stress response and emergence agitation in elderly patients undergoing hip arthroplasty in Xining.Methods:The clinical data of 60 elderly patients undergoing hip arthroplasty were analyzed retrospectively.They were divided into observation group(n=30) and control group(n=30) according to different anesthesia methods.Before anesthesia induction with sufentanil,observation group and control group were given intravenous injection of nalbuphine and the same volume of normal saline,respectively.The systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),cortisol(Cor) and blood glucose(Glu) in the two groups were comparedat entering the room(T0),immediately after intubation(T1) and immediately after extubation(T2).The recovery time of autonomous respiration and orientation,extubation time,agitation score,Ramasay score and adverse reactions in both groups were recorded.The changes in scores of visual analogy scale(VAS) and mini-mental state examination(MMSE) in the two groups were compared at different time points.Results:SBP,DBP,HR,Glu and Cor in the observation group at T1 and T2 were lower than those in the control group,the difference were statistically significant(P<0.05).The recovery time of autonomous respiration and orientation,and extubation time in observation group were shorter than those in control group(P<0.05).The agitation score in observation group at 5 min after extubation was lower than that in control group(P<0.05),while Ramasay score was higher than that in control group(P<0.05).At 2,12 and 24 h after surgery,VAS scores in observation group were lower than those in control group(P<0.05).At 1 d and 3 d after surgery,MMSE scores in observation group were higher than those in control group(P<0.05).At 48 h after surgery,the incidence of adverse reactions was lower in observation group than that in the control group(6.67% vs.26.67%,P<0.05).Conclusion:Thenalbuphine combined with sufentanil can maintai

关 键 词：髋关节置换术 老年 纳布啡 舒芬太尼 应激反应 苏醒期躁动 

分 类 号：R614.2[医药卫生—麻醉学]