盐酸纳布啡联合右美托咪定在腹腔镜胆囊切除术中的应用  

Application of nalbuphine hydrochloride combined with dexmedetomidine in laparoscopic cholecystectomy

作　　者：薛行行 薛蓉 王丽[1] XUE Xing-xing;XUE Rong;WANG Li(Department of Anesthesiology,the First Hospital of Yulin,Yulin 718000,Shaanxi,CHINA)

机构地区：[1]榆林市第一医院麻醉科,陕西榆林718000

出　　处：《海南医学》2023年第3期348-351,共4页Hainan Medical Journal

摘　　要：目的探讨盐酸纳布啡联合右美托咪定在腹腔镜胆囊切除术(LC)中的应用效果。方法回顾性分析2018年11月至2020年10月在榆林市第一医院行LC治疗的100例患者的临床资料,按照麻醉方式不同分为观察组53例和对照组47例。对照组患者给予利多卡因联合氯化钠注射液麻醉,观察组患者给予盐酸纳布啡联合右美托咪定麻醉。术毕比较两组患者麻醉情况,记录麻醉诱导前(T0)、插管后(T1)、气腹后(T2)、术中(T3)、术后拔管(T4)时血栓素2(TXA2)、内皮素(ET)及术后6 h、12 h、24 h、48 h的视觉模拟疼痛(VAS)评分,统计两组患者的不良反应发生情况。结果观察组患者的苏醒、拔管、肛门排气时间及Ramsay镇静评分分别为(17.31±3.98)min、(12.38±2.98)min、(31.31±5.09)h、(2.31±0.28)分,明显短(低)于对照组的(23.31±3.61)min、(19.31±2.87)min、(42.41±3.89)h、(1.52±0.42)分,差异均有统计学意义(P<0.05);T2、T3、T4时,两组患者的TXA2、ET水平明显升高,但观察组患者的TXA2、ET水平明显低于对照组,差异均具有统计学意义(P<0.05);观察组患者术后6 h、12 h、24 h及24 h的VAS评分分别为(1.68±0.41)分、(2.28±0.32)分、(2.78±0.31)分、(1.20±0.18)分,明显低于对照组的(1.89±0.31)分、(2.65±0.32)分、(3.01±0.21)分、(1.62±0.24)分,差异均有统计学意义(P<0.05);观察组患者的总不良反应发生率为5.66%,略低于对照组的8.51%,但差异无统计学意义(P>0.05)。结论盐酸纳布啡联合右美托咪定应用于LC中,可有效调节患者的TXA2、ET水平,缓解疼痛,麻醉效果理想且不良反应低,具有临床推广应用价值。Objective To investigate the effect of nalbuphine hydrochloride combined with dexmedetomidine in laparoscopic cholecystectomy(LC).Methods The clinical data of 100 patients who underwent LC treatment in the First Hospital of Yulin from November 2018 to October 2020 were retrospectively analyzed.According to different anesthesia methods,they were divided into an observation group(n=53)and a control group(n=47).The patients in the control group were given lidocaine combined with sodium chloride injection for anesthesia,while the patients in the observation group were given nalbuphine hydrochloride combined with dexmedetomidine for anesthesia.After the operation,the anesthesia conditions were compared between the two groups.The thromboxane 2(TXA2),endothelin(ET)before anesthesia induction(T0),after intubation(T1),after pneumoperitoneum(T2),during operation(T3)and after extubation(T4),and the Visual Analogue Scale(VAS)scores at 6 h,12 h,24 h,and 48 h after operation were recorded,and the adverse reactions of the two groups were statistically analyzed.Results The recovery,extubation,anal exhaust time,and Ramsay Sedation score in the observation group were(17.31±3.98)min,(12.38±2.98)min,(31.31±5.09)h,(2.31±0.28)points,respectively,which were significantly shorter(lower)than(23.31±3.61)min,(19.31±2.87)min,(42.41±3.89)h,(1.52±0.42)points in the control group(P<0.05).At T2,T3,and T4,the levels of TXA2 and ET in the two groups were significantly increased,but the levels of TXA2 and ET in the observation group were significantly lower than those in the control group,with statistically significant differences(P<0.05).The VAS scores at 6 h,12 h,24 h,and 24 h in the observation group were(1.68±0.41)points,(2.28±0.32)points,(2.78±0.31)points,and(1.20±0.18)points,which were significantly lower than(1.89±0.31)points,(2.65±0.32)points,(3.01±0.21)points,and(1.62±0.24)points in the control group(P<0.05).The total adverse reaction rate in the observation group was 5.66%,slightly lower than 8.51%in the control group(P>0

关 键 词：腹腔镜胆囊切除术 盐酸纳布啡 右美托咪定 疼痛 血栓素A2 内皮素 不良反应 

分 类 号：R657.4[医药卫生—外科学]