不同用药时机低剂量阿片类药物用于妇科腔镜手术围术期效果评价  

Evaluation of the Perioperative Effects of Low-Dose Opioids Administrated at Different Time Points in Gynecologic Laparoscopic Surgery

作　　者：王伟 李雁军 王俊星 周晓奇 任昕 姚豆 WANG Wei;LI Yanjun;WANG Junxing;ZHOU Xiaoqi;REN Xin;YAO Dou(Yuncheng Central Hospital,Yuncheng,Shanxi,China 044000)

机构地区：[1]山西省运城市中心医院,山西运城044000

出　　处：《中国药业》2025年第6期86-89,共4页China Pharmaceuticals

基　　金：山西省运城市科技计划项目[YCKJ-2021056-1]。

摘　　要：目的探讨妇科腔镜手术围术期不同时机给予低剂量阿片类药物的临床价值。方法选取医院2021年7月至2023年7月收治拟行妇科腔镜手术患者120例,按阿片类药物不同给药时机采用分层区组随机化分组方法分为4组,各30例。Z1组、Z2组分别于术前15 min及手术结束前30 min静脉注射枸橼酸舒芬太尼注射液0.1μg/kg+盐酸纳布啡注射液40 mg,Z3组联用前两组方案,Z0组不使用上述两药。结果与其他3组比较,Z1组患者意识恢复时间、吞咽反射恢复时间和术后拔管时间均显著缩短(P<0.05),Z2组患者3个时间均显著延长(P<0.05);与Z0组比较,Z1组、Z2组、Z3组患者视觉模拟评分均显著降低(P<0.05);治疗后各组患者5-羟色胺和脑内神经肽水平均显著升高,且Z2组显著高于其他3组(P<0.05)。各组不良反应发生率无显著差异(P>0.05)。结论对妇科腹腔镜围术期患者,应用多模式镇痛下的低剂量阿片类药物,能减轻患者的疼痛程度;术前行低剂量阿片类药物干预,可有效缩短患者恢复时间,术中使用虽会延长麻醉复苏时间,但能减轻患者术后疼痛。Objective To explore the clinical value of administering low-dose opioids at different perioperative time points in gynecologic laparoscopic surgery.Methods A total of 120 patients scheduled for gynecologic laparoscopic surgery at the hospital from July 2021 to July 2023 were selected and randomly divided into four groups(30 cases each)based on the administration timing of opioids using a stratified block randomization method.Group Z1 and group Z2 received intravenous injections of sufentanil citrate(0.1μg/kg)and nalbuphine hydrochloride(40 mg)15 minutes before surgery and at the end of surgery,respectively.Group Z3 received a combination of both regimens,while group Z0 did not receive either drug.Results Compared with the other three groups,consciousness recovery time,swallowing reflex recovery time,and postoperative extubation time in group Z1 significantly shortened(P<0.05).Compared to the other groups,consciousness recovery time in group Z2 significantly prolonged(P<0.05).Compared with group Z0,the VAS scores in group Z1,group Z2,and group Z3 were significantly reduced(P<0.05).After treatment,serotonin and central neuropeptide levels significantly increased in all groups,with group Z2 showing the highest levels(P<0.05).There was no significant difference in the incidence of adverse reactions among the groups(P>0.05).Conclusion The application of low-dose opioids under multimodal analgesia in perioperative gynecologic laparoscopic patients can alleviate pain.Preoperative administration of low-dose opioids effectively shortens recovery time,while intraoperative administration,although prolonging anesthesia recovery time,helps alleviate postoperative pain.

关 键 词：给药时机 低剂量 阿片类药物 妇科腔镜术 围术期 安全性 

分 类 号：R969.4[医药卫生—药理学]