摘要
目的:观察纳布啡超前镇痛对颅脑外科手术患者全麻苏醒期躁动的干预效果,并探讨其对炎症反应的影响。方法:选择ASAⅠ级/Ⅱ级择期行颅脑肿瘤切除术的全麻患者100例,分为纳布啡组(N组)和对照组(C组)各50例。手术开始之前15 min,N组静脉注射纳布啡0.2 mg/kg,C组给予等体积生理盐水;术后接同一配方静脉镇痛泵(PCA)。观察和记录患者全麻苏醒期躁动发生情况、拔管后Ramsay镇静评分和VAS疼痛评分,记录术后PCA追加次数。记录麻醉诱导前(T0)、手术开始时(T1)、手术缝皮结束时(T2)、拔管时(T3)、拔管后5 min(T4)、拔管后30 min(T5)、拔管后120 min(T6)的心率(HR)和平均动脉压(MAP),检测血清IL-6、CRP和TNF-α的浓度。结果:与C组比较,N组T1~T6的血清CRP、IL-6和TNF-α浓度降低,MAP、HR也降低(P<0.05);躁动发生率降低(P=0.043);T4~T6时VAS疼痛评分和术后PCA追加次数均减少(P<0.05),且N组无镇静过度发生。结论:纳布啡超前镇痛可减轻颅脑外科手术患者炎性反应和术后早期急性疼痛,稳定血流动力学指标,减少全麻苏醒期躁动。
Aim:To investigate the effects of preemptive analgesia with nalbuphine on inflammatory factors and emergence agitation in patients undergoing craniocerebral surgery.Methods:One hundred patients who were going to undergo craniocerebral surgery were allocated into nalbuphine group(group N)and control group(group C)with 50 cases in each group.Group N received nalbuphine intravenously at a dose of 0.2 mg/kg before the operation.Group C received the same volume of normal saline.The same intravenous analgesia pump was adopted after operation.The heart rate(HR)and mean arterial pressure(MAP)were recorded before anesthesia(T0),at the beginning of the operation(T1),at the end of the operation(T2),at the time of extubation(T3),5 min,30 min,and 120 min after extubation(T4,T5,and T6).The serum levels of IL-6,CRP,and TNF-αwere measured at the different time points.The agitation,Ramsay score,VAS score and the total number of additional times of intravenous PCA in emergence agitation were recorded.Results:At T1-T6,the serum levels of CRP,IL-6 and TNF-αin group N were lower than those of group C(P<0.05).The MAP and HR at each time point(T1-T6)in group N were lower than those of group C(P<0.05).Compared with the group C,the incidence of agitation in the group N were reduced(P=0.043).The total number of additional times of intravenous PCA in group N was fewer than that of group C,and the VAS score at T4-T6 was lower(P<0.05).There was no over sedation in group N.Conclusions:Advanced analgesia of nalbuphine could reduce early postoperative acute pain and inflammatory reaction in patients undergoing craniocerebral surgery,keep haemodynamics stable,and reduce the incidence of emergence agitation.
作者
苏冠男
王凯利
董铁立
夏莉
SU Guannan;WANG Kaili;DONG Tieli;XIA Li(Department of Anesthesiology in Surgery Branch, the Second Affiliated Hospital,Zhengzhou University, Zhengzhou 450014)
出处
《郑州大学学报（医学版）》
CAS
北大核心
2020年第5期685-689,共5页
Journal of Zhengzhou University(Medical Sciences)
基金
河南省科技攻关项目(182102310084)。
关键词
纳布啡
超前镇痛
全麻苏醒期躁动
炎性因子
颅脑外科手术
nalbuphine
preemptive analgesia
emergence agitation
inflammatory factor
craniocerebral surgery
