摘要
目的:探究右美托咪定复合纳布啡对腹腔镜全子宫切除术患者术后疼痛、睡眠质量、认知功能及前列腺素E_(2)(PGE_(2))的影响。方法:选取2020年4月-2022年4月在本院行腹腔镜全子宫切除术患者90例,随机分为对照组(45例)和联合组(45例),分别给予纳布啡镇痛或右美托咪定复合纳布啡镇痛。比较两组术后指标,疼痛[疼痛视觉模拟评分(VAS)],睡眠质量[非快速眼动睡眠(NREM)、REM、睡眠效率及主观睡眠质量],认知功能[简易精神状态评价量表(MMSE)],血清PGE_(2)水平及不良反应。结果:联合组拔管时间(18.2±1.9min)、苏醒时间(16.9±1.7min)及躁动发生率(15.6%)均低于对照组(20.4±2.1miin、18.4±1.9min、35.6%),术后6h、12h、24h两组VAS评分逐渐降低,且联合组12h、24h时低于对照组(均P<0.05);与术前1d相比,两组术后1d、3d N1、N2期NREM均升高,联合组N3期NREM降低,与术后1d相比,联合组术后3d N1期NREM降低,N3期升高(均P<0.05);对照组术后1d、3d各期NREM比较无差异(P>0.05),与术前1d相比,两组术后1d REM、睡眠效率、主观睡眠质量均降低,但联合组术后3d高于术后1d(均P<0.05),对照组无明显变化(P>0.05)。两组MMSE评分逐渐升高,且联合组术后2d、3d高于对照组(均P<0.05)。血清PGE_(2)水平联合组术后12h、24h均低于术后6h,对照组术后6h、12h、24h逐渐降低,且联合组同时点血清PGE_(2)水平均低于对照组(均P<0.05)。两组不良反应发生率(15.6%、11.1%)无差异(P>0.05)。结论:右美托咪定复合纳布啡用于腹腔镜全子宫切除术可有效减轻患者术后疼痛,改善睡眠质量及认知功能,调节血清PGE_(2)水平,安全有效。
Objective:To investigate the impacts of dexmedetomidine combined with nalbuphine used during laparo-scopic total hysterectomy of patients on their postoperative pain,sleep quality,cognitive function,and prostaglandin E_(2)(PGE)level.Methods:90 patients who wanted laparoscopic hysterectomy were selected and were randomly divided into two groups(45 cases in cach group)from April 2020 to April 2022.The patients in the control group were given nalbuphine for analgesia,and the patients in the study group were given dexmedetomidine combined with nalbuphine for analgsia.The postoperative indicators,the pain degree evaluated by visual analog scale(VAS),the sleep quality devalued by non rapid eye movement(NREM),rapid eye mowement(REM),sleep efficiency.and subjective sleep quality,the cognitive function devalued by Mini Mental State Evaluation Scale(MMSE),the serum PGE_(2)level,and the occurrence of adverse reactions of the patients were compared between the two groups.Results:The extubation time(18.2±1.9min),the recovery time(16.9±1.7min),and the incidence of agitation(15.6%)of the patients in the study group were significantly lower than those(20.4±2.1min,18.4±1.9min,and 35.6%)of the patients in the control group.The VAS scores of the patients in both groups at 6h,12h,and 24h after surgery had decreased gradually,and which of the patients in the study group at 12h and 24h after surgery were significantly lower than those of the patients in the control group(P<0.05).The NREM value in N1 stage and N2 stage of the patients in both groups in 1 day and 3 days after surgery was significantly higher than that in 1 day before surgery,while the NREM value in N3 stage of the patients in the study group in 1 day and 3 days after surgery was significantly lower than that in 1 day before surgery.The NREM value in NI stage of the patients in the study group in 3 day after surgery was significantly lower than that in 1 day after surgery,but which in N3 stage was significantly higher(all P<0.05).There was no significant difference in the NREM walue of the patients in the control group in 1 day and 3 days after surgery among dif-ferent stages of NREM(P>0.05).The REM value,the sleep eficiency,and the subiective sleep quality eficiency of the patients in the two groups in 1 day after surgery were significantly lower than those in 1 day before surgery,but which of the patients in the study group in 3 day after surgery were significantly higher than those in 1 day after surgery(all P<0.05).There were no significant dffrences in the REM value,the sleep fficiency,and the subjective sleep quality eficiency of the patients in the control group among 1 day before surgery,1 day after surgery,and 3 day after surgery(P>0.05).The MMSE score of the patients in the two groups had increased gradually.and which of the pa-tients in the study group in postoperative 2d and 3d were significantly higher than those of the patients in the control group(all P<0.05).The serum PGE:levels of the patients in the study group at 12h and 24h after surgery were all significantly lower than those at 6h after surgery.The serum PGE:level of the patients in the control group at 6h,12h,and 24h after surgery had decreased gradually,and which of the patients in the study group at 6h,12h,and 24h after surgery was significantly lower than that of the patients in the control group(all P<0.05).There was no signifi-cant difference in the incidence of adverse reactions(15.6%vs.11.1%)of the patients between the two groups(P>0.05).Conclusion:Dexmedetomidine combined with nalbuphine used in laparoscopic hysterectomy of the patients can efctively relieve their postoperative pain,improve their sleep quality and cognitive function,and regulate their PGE。level,and which is safe and ffective.
作者
俞慧
徐晓栋
柯旭
YU Hui;XU Xiaodong;KE Xu(Hefei Third Clinical College of Anhui Medical University(Hefei Third People's Hospital),Anhui Province,230022)
出处
《中国计划生育学杂志》
2023年第8期1833-1838,共6页
Chinese Journal of Family Planning
