氢吗啡酮联合κ受体激动剂纳布啡对腹腔镜全子宫切除术后患者镇痛和免疫功能的影响  

Effects of hydromorphone combined withκreceptor agonist nabophan on analgesia and immune function after laparoscopic total hysterectomy

作　　者：唐杰 张博 张蕾 TANG Jie;ZHANG Bo;ZHANG Lei(Xi’an People’s Hospital,Xi’an 710004,China)

机构地区：[1]西安市人民医院,西安市第四医院麻醉与围手术医学科,陕西西安710004

出　　处：《陕西医学杂志》2024年第10期1381-1386,共6页Shaanxi Medical Journal

基　　金：陕西省科学技术项目(2023-YBSF-332);西安市科技计划项目(22YXYJ0013)。

摘　　要：目的:观察纳布啡复合氢吗啡酮对腹腔镜全子宫切除术后患者自控静脉镇痛(PCIA)和免疫功能的影响。方法:将103例择期行腹腔镜全子宫切除术的患者随机分为观察组(n=52)和对照组(n=51),两组均实施气管插管静脉全麻,并在术后接受PCIA直至术后48 h,对照组以PCIA实施方案为枸橼酸舒芬太尼注射液(2.0μg/kg)+盐酸纳布啡注射液(0.8 mg/kg)+0.9%氯化钠注射液100 ml。观察组为盐酸氢吗啡酮注射液(2.0μg/kg)+盐酸纳布啡注射液(0.1 mg/kg)+0.9%氯化钠注射液100 ml。观察术后不同时间点疼痛视觉模拟评分(VAS)、术后48 h镇痛效果、术后恢复情况,术后不同时间点免疫功能指标的变化。记录两组术后48 h内的不良反应。结果:与对照组比较,观察组术后6、12、24 h静息时VAS评分较低,差异有统计学意义(均P<0.05),但在术后48 h两组比较差异无统计学意义(P>0.05);观察组活动时术后6~48 h的VAS评分均低于对照组,差异有统计学意义(P<0.05)。观察组镇痛泵总按压次数和有效按压次数、补救镇痛和托烷司琼用量均低于对照组,术后首次排气时间、首次进食时间、首次下床时间均短于对照组,差异有统计学意义(均P<0.05),两组术后住院时间比较差异无统计学意义(P>0.05)。与术前比较,两组术后6~24 h的CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)均显著降低,CD8^(+)显著增加,差异有统计学意义(均P<0.05),在术后48 h时观察组上述指标与术前比较差异无统计学意义(P>0.05)。而对照组与术前比较差异仍有统计学意义(P<0.05)。观察组在术后6~24 h的CD8^(+)低于对照组,其余指标均高于对照组,差异有统计学意义(均P<0.05)。与对照组比较,观察组48 h内的恶心、头晕发生率均较低,差异有统计学意义(均P<0.05)。结论:与纳布啡复合舒芬太尼相比,腹腔镜全子宫切除术后PCIA中采用纳布啡复合氢吗啡酮的镇痛效果更佳,患者术后恢复和免疫功能改善情况更�Objective:To observe the effect of nabophan combined with hydromorphone on patient controlled intravenous analgesia(PCIA)and immune function in patients after laparoscopic total hysterectomy.Methods:A total of 103 patients who underwent elective laparoscopic total hysterectomy were randomly divided into observation group(52 cases)and control group(51 cases).Both groups underwent endotracheal intubation intravenous general anesthesia,and received PCIA until 48 hours after surgery.The control group was implemented by PCIA as sufentanil citrate injection(2.0μg/kg)+nalbuphine hydrochloride injection(0.8 mg/kg)+0.9%sodium chloride injection 100 ml.The observation group was hydromorphone hydrochloride injection(2.0μg/kg)+nalbuphine hydrochloride injection(0.1 mg/kg)+0.9%sodium chloride injection 100 ml.The analgesic effect at 48 hours after surgery,postoperative recovery,and the changes of immune function indexes and Visual Analogue Score(VAS)at different time points after surgery were observed.The adverse reactions of the two groups within 48 hours after surgery were recorded.Results:Compared with the control group,the VAS scores at rest at 6,12 and 24 hours in the observation group were lower(all P<0.05),but there was no significant difference between the two groups at 48 hours after surgery(all P>0.05).The VAS scores in the observation group were lower than those in the control group at 6 to 48 hours after operation(P<0.05).The total number of analgesic pump compressions,effective compressions,salvage analgesia and tropisetron dosage in the observation group were lower than those in the control group,and the time of first postoperative gassing,first feeding and first time of getting out of bed were shorter than those in the control group(all P<0.05),while there was no significant difference in postoperative hospital stay between the two groups(all P>0.05).Compared with the preoperative period,the CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)levels in the two groups were significantly decreased at 6 to 24 hours after surgery,

关 键 词：纳布啡 氢吗啡酮 腹腔镜全子宫切除术 患者自控静脉镇痛 免疫功能 术后恢复 

分 类 号：R713.4[医药卫生—妇产科学]