纳布啡联合右美托咪定预防性镇痛对鼻内镜手术患者血流动力学和术后疼痛的影响

Clinical effect of preventive analgesia with nalbuphine and dexmedetomidine on hemodynamics and postoperative pain in patients underwent endoscopic sinus surgery

摘要:

目的 探讨纳布啡联合右美托咪定预防性镇痛对鼻内镜手术患者血流动力学和术后疼痛的影响。方法 选取择期在鼻内镜下行鼻中隔偏曲矫正术的患者60例，随机分为右美托咪定联合纳布啡组（DN组）和右美托咪定组（D组），每组30例。D组于麻醉诱导前15 min给予右美托咪定0.5 μg/kg泵注；DN组于麻醉诱导前15 min给予右美托咪定0.5 μg/kg泵注，同时静脉注射纳布啡0.20 mg/kg。观察麻醉前（T₁）、插管后即刻（T₂）、手术开始时（T₃）、气管导管拔除即刻（T₄）和拔管后5 min（T₅）的平均动脉压（MAP）和心率（HR），记录术中丙泊酚、舒芬太尼和瑞芬太尼用量，以及苏醒和拔管时间，用数字分级评分（NRS）评估拔管后0.5 h（T₆）、4.0 h（T₇）、8.0 h（T₈）和24.0 h（T₉）的疼痛情况，记录补救镇痛率及不良反应发生率。结果 与T₁时点比较，D组T₂～T₅时点MAP明显升高，HR明显加快（P < 0.05），DN组T₂～T₅时点MAP和HR与T₁时点比较，差异无统计学意义（P > 0.05）。DN组T₂～T₅时点MAP明显低于D组，HR明显慢于D组（P < 0.05），T₆～T₉时点NRS明显较D组低（P < 0.05），瑞芬太尼和丙泊酚用量明显较D组少（P < 0.05），补救镇痛率明显较D组低（P < 0.05）。结论 在鼻内镜手术中使用纳布啡联合右美托咪定预防性镇痛，可稳定患者血流动力学，减少术中麻醉药物用量，减轻术后疼痛，对苏醒及拔管时间无明显影响。

Abstract:

Objective To study the effect of preventive analgesia with nalbuphine and dexmedetomidine on hemodynamics and postoperative pain in patients underwent endoscopic sinus surgery.Methods 60 patients scheduled for endoscopic sinus surgery under general anesthesia were divided into dexmedetomidine group (group D) and dexmedetomidine combined with nalbuphine group (group DN) according to the random number table method, with 30 cases in each group. Patients in group D received intravenous infusion of dexmedetomidine at 0.5 μg/kg 15 min prior to the induction of anesthesia; Patients in group DN received intravenous infusion of dexmedetomidine at 0.5 μg/kg and intravenous injection of nalbuphine 0.20 mg /kg 15 min prior to the induction of anesthesia. Mean arterial pressure (MAP) and heart rate (HR) at different time points were recorded: before anesthesia (T₁), at the time of intubation (T₂), at the beginning of the operation (T₃), at the time of extubation (T₄) and 5 min after extubation (T₅). The consumption of propofol, sufentanil and remifentanil during surgery, the recovery time and extubation time were recorded. The numerical rating scale (NRS) of 0.5 h (T₆), 4.0 h (T₇), 8.0 h (T₈) and 24.0 h (T₉) after extubation were measured, and the remedial anesthetics rate and the incidence of adverse reactions were recorded.Results Compared with T₁, MAP and HR at T₂ ~ T₅ in group D were increased significantly (P < 0.05), and there was no significant difference in MAP and HR in DN group (P > 0.05). Compared with group D, MAP and HR in group DN decreased significantly at T₂ ~ T₅ (P < 0.05). Compared with group D, the NRS score at T₆ ~ T₉ in group DN were significantly lower (P < 0.05), the dosage of remifentanil and propofol in group DN were significantly less (P < 0.05), the remedial analgesia rate was significantly lower (P < 0.05).Conclusion Nalbuphine combined with dexmedetomidine for preventive analgesia in endoscopic sinus surgery can stabilize hemodynamics, reduce the dosage of anesthetics during operation and postoperative pain without affecting the time of awakening and extubation.