纳布啡结合腹横肌平面阻滞多模式镇痛对肝癌根治性切除术后患者的镇痛效果研究  

Analgesia effect of multimodal analgesia with nalbuphine combined with transversus abdominis plane block on patients after radical resection of liver cancer

作　　者：张沛重[1] 徐国亭[1] 王苗级 ZHANG Pei-zhong;XU Guo-ting;WANG Miao-ji(Department of Anesthesiology and Perioperative Medicine,The First Affiliated Hospital of Nanyang Medical College,Nanyang 473000,Henan Province,China)

机构地区：[1]南阳医学高等专科学校第一附属医院麻醉与围术期医学科,河南南阳473000

出　　处：《中国临床药理学杂志》2024年第18期2635-2639,共5页The Chinese Journal of Clinical Pharmacology

摘　　要：目的评价纳布啡结合腹横肌平面阻滞(TAPB)多模式镇痛对肝癌根治性切除术后患者的镇痛效果,并观察其安全性。方法将行肝癌根治性切除术患者根据麻醉方案不同按队列法分为对照组和试验组。对照组行TAPB结合使用2μg·kg^(-1)舒芬太尼+昂丹司琼16mg进行患者自控静脉镇痛(PCIA),试验组行TAPB结合用2mg·kg^(-1)纳布啡+昂丹司琼16mg进行PCIA。比较2组患者的围术期麻醉药物用量、心率(HR)、麻醉效果、术后视觉模拟评分(VAS)和舒适度评分(BCS),记录2组镇痛泵总按压次数、有效按压次数和补救镇痛率,并进行安全性评价。结果对照组和试验组分别纳入57例和53例进行分析。试验组和对照组气管拔管后5minHR分别为(66.38±7.65)和(70.74±8.12)beat·min^(-1),术后48hVAS评分分别为(1.14±0.36)和(1.75±0.69)分,BCS评分分别为(2.51±0.45)和(2.30±0.55)分,PCIA术后镇痛泵总按压次数分别为(6.89±1.75)和(12.61±2.39)次,有效按压次数分别为(3.64±0.91)和(8.27±1.15)次,补救镇痛率为分别5.66%(3例/53例)和19.30%(11例/57例),恶心呕吐发生率为分别5.66%(3例/53例)和19.30%(11例/57例),在统计学上差异均有统计学意义(均P<0.05)。试验组和对照组麻醉总优良率分别为96.23%(51例/53例)和89.47%(51例/57例),药物不良反应发生率分别为11.32%(6例/53例)和22.81%(13例/57例),在统计学上差异均无统计学意义(均P>0.05)。结论纳布啡结合TAPB多模式镇痛在肝癌根治性切除术后具有良好的镇痛效果,有利于减少术后恶心呕吐的发生,安全有效。Objective To evaluate the analgesia effect of nalbuphine combined with transversus abdominis plane block(TAPB)multimodal analgesia on patients after radical resection of liver cancer,and to observe its safety.Methods The clinical data of patients who underwent radical resection of liver cancer were retrospectively collected.According to different postoperative anesthesia regimens,they were divided into control group and treatment group by the cohort method.The control group was treated with TAPB combined with 2μg·kg^(-1)sufentanil+ondansetron 16 mg for patient-controlled intravenous analgesia(PCIA),while the treatment group was given TAPB combined with 2 mg·kg^(-1)nalbuphine+ondansetron 16 mg for PCIA.The perioperative anesthetic dosage,heart rate(HR),anesthesia effect,postoperative visual analogue scale(VAS)and Bruggman comfort score(BCS)were compared,and the total number of analgesia pump compressions,the number of effective compressions,remedial analgesia rate,postoperative ambulation time,postoperative exhaust time and occurrence of drug-related adverse reactions were recorded in the two groups.Results 57 cases in control group and 53 cases in treatment group were included for analysis.The HR values at 5 min after tracheal extubation in treatment group and control group were(66.38±7.65)and(70.74±8.12)beat·min^(-1),VAS scores at 48 h after surgery were(1.14±0.36)and(1.75±0.69)points,BCS scores were(2.51±0.45)and(2.30±0.55)points,the total number of analgesia pump compressions after PCIA were(6.89±1.75)and(12.61±2.39)times,the number of effective compressions were(3.64±0.91)and(8.27±1.15)times,the remedial analgesia rates were 5.66%(3 cases/53 cases)and19.30%(11 cases/57 cases),the incidence rates of nausea and vomiting were 5.66%(3 cases/53 cases)and19.30%(11 cases/57 cases),respectively(all P<0.05).The overall excellent and good rates of anesthesia in treatment group and control group were 96.23%(51 cases/53 cases)and 89.47%(51 cases/57 cases),the total incidence rates of adverse drug reactions

关 键 词：纳布啡 肝癌根治性切除术 腹横肌平面阻滞 多模式镇痛 安全性 

分 类 号：R971.2[医药卫生—药品]