纳布啡联合舒芬太尼在老年髋关节置换术中的麻醉效果评价  

Evaluation of the anesthetic effect of nalbuphine combined with sufentanil in elderly patients undergoing hip arthroplasty

作　　者：赵忠军 ZHAO Zhong-jun(Shanxian County Hospital of Traditional Chinese Medicine,Heze 274300,China)

机构地区：[1]单县中医医院,274300

出　　处：《中国现代药物应用》2025年第4期126-130,共5页Chinese Journal of Modern Drug Application

摘　　要：目的探讨老年髋关节置换术中应用纳布啡联合舒芬太尼的麻醉效果。方法92例老年髋关节置换术患者,依照麻醉方法不同分为分为研究组(麻醉诱导前予以患者纳布啡)、对照组(麻醉诱导前予以患者等量氯化钠溶液),各46例。比较两组患者舒张压(DBP)、收缩压(SBP)、心率(HR)、疼痛程度、认知功能、苏醒期质量指标(自主呼吸恢复时间、苏醒时间、拔管时间、睁眼时间、定向力恢复时间、拔管后5 min躁动评分、拔管后5 min Ramasay评分)、疼痛因子[前列腺素E_(2)(PGE_(2))、血清P物质(SP)、肾上腺素(E)、去甲肾上腺素(NE)]、不良反应发生情况。结果手术结束时,两组DBP、HR、SBP水平均较术前升高,但研究组患者DBP(87.45±4.68)mm Hg(1 mm Hg=0.133 kPa)、HR(87.43±4.52)次/min、SBP(137.47±8.75)mm Hg均低于对照组的(92.52±4.54)mm Hg、(94.56±4.41)次/min、(149.54±8.82)mm Hg,有差异(P<0.05)。术后24 h,两组视觉模拟评分法(VAS)、简易智力状态检查量表(MMSE)评分均较术前降低,但研究组患者VAS评分(1.45±0.37)分低于对照组的(2.52±0.48)分,MMSE评分(27.43±0.89)分高于对照组的(26.56±0.85)分,有差异(P<0.05)。研究组患者自主呼吸恢复时间(6.92±1.27)min、苏醒时间(6.55±1.13)min、拔管时间(11.25±2.32)min、睁眼时间(11.15±1.38)min、定向力恢复时间(8.85±1.87)min均短于对照组的(9.16±1.48)、(9.93±1.22)、(14.58±2.71)、(12.62±1.46)、(13.22±1.14)min,拔管后5 min躁动评分(1.06±0.23)分低于对照组的(1.88±0.31)分,拔管后5 min Ramasay评分(3.23±0.45)分高于对照组的(2.17±0.34)分,有差异(P<0.05)。术后24 h,两组血清PGE_(2)、SP、E、NE水平均较术前升高,但研究组患者血清PGE_(2)(14.42±2.66)ng/ml、SP(97.41±14.54)pg/ml、E(65.44±5.76)pg/ml、NE(297.12±31.14)pg/ml低于对照组的(18.55±2.53)ng/ml、(119.55±12.43)pg/ml、(71.56±5.81)pg/ml、(389.58±42.63)pg/ml,有差异(P<0.05)。研究组不良反应发生率4.35%低Objective To explore the anesthetic effect of nalbuphine combined with sufentanil in elderly patients undergoing hip arthroplasty.Methods According to different anesthesia methods,92 elderly patients with hip arthroplasty were divided into study group(treated with nalbuphine before anesthesia induction)and control group(treated with equal amount of sodium chloride solution before anesthesia induction),each with 46 cases.Patients in both groups were compared in terms of diastolic blood pressure(DBP),systolic blood pressure(SBP),heart rate(HR),pain severity,cognitive function,quality indicators during the awakening period(recovery time of spontaneous respiration,awake time,extubation time,eye opening time,orientation recovery time,agitation score at 5 min after extubation,Ramasay score at 5 min after extubation),pain factor[prostaglandin E_(2)(PGE_(2)),serum substance P(SP),epinephrine(E),norepinephrine(NE)],occurrence of adverse reactions.Results At the end of surgery,DBP,HR and SBP levels were increased in both groups compared with before surgery;the study group had DBP of(87.45±4.68)mm Hg(1 mm Hg=0.133 kPa),HR of(87.43±4.52)beats/min and SBP of(137.47±8.75)mm Hg,which were lower than(92.52±4.54)mm Hg,HR(94.56±4.41)beats/min and(149.54±8.82)mm Hg in the control group;there was a difference(P<0.05).At 24 h after surgery,the scores of visual analogue scale(VAS)and mini-mental state examination(MMSE)were decreased in both groups;the study group had lower VAS score of(1.45±0.37)points than(2.52±0.48)points in the control group,and higher MMSE score of(27.43±0.89)points than(26.56±0.85)points in the control group;there was a difference(P<0.05).In the study group,the recovery time of spontaneous respiration was(6.92±1.27)min,the awake time was(6.55±1.13)min,the extubation time was(11.25±2.32)min,the eye opening time was(11.15±1.38)min and the orientation recovery time was(8.85±1.87)min,which were all shorter than those(9.16±1.48),(9.93±1.22),(14.58±2.71),(12.62±1.46)and(13.22±1.14)min in the control

关 键 词：髋关节置换术 纳布啡 舒芬太尼 认知功能 应激 苏醒质量 老年 

分 类 号：R61[医药卫生—外科学]