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不同剂量纳布啡联合丙泊酚对宫腔镜手术患者麻醉和镇痛效果的影响
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| 篇名： | 不同剂量纳布啡联合丙泊酚对宫腔镜手术患者麻醉和镇痛效果的影响 |
| TITLE： | |
| 摘要： | 目的：探讨不同剂量纳布啡联合丙泊酚对宫腔镜手术患者麻醉和镇痛效果的影响。方法：选取2016年2－11月拟行无痛宫腔镜手术的住院患者120例作为研究对象，采用随机数字表法分为P、N1、N2、N3组，各30例。4组患者均进行常规的术前准备，N1、N2和N3组患者分别于1～2 min内缓慢给予盐酸纳布啡注射液0.05、0.10、0.15 mg/kg，iv ；注射3 min后，4组患者均给予2％盐酸利多卡因注射液2 mL，iv+丙泊酚注射液1 mg/kg，iv（40 mg/10 s），再缓慢推注（10 mg/10 s）丙泊酚注射液至患者睫毛反射消失、呼之无应答；术中丙泊酚注射液均以6 mg/（kg·h）的速度经微泵输注维持麻醉至手术结束。观察入室时（T0）、丙泊酚推注前（T1）、丙泊酚推注完毕即刻（T2）、扩宫颈时（T3）、手术结束时（T4）和麻醉苏醒时（T5）4组患者的血流动力学指标[收缩压（SBP）、舒张压（DBP）、心率（HR）]和血氧饱和度（SpO2）水平，以及丙泊酚诱导剂量、维持剂量、总剂量、总给药时间、单位时间剂量和患者麻醉苏醒时间和麻醉苏醒时数字疼痛分级法（NRS）评分，并记录术中及麻醉恢复期的不良反应发生情况。结果：4组患者丙泊酚维持剂量、总给药时间及体动反应、低血压、窦性心动过缓和恶心呕吐的发生率比较，差异均无统计学意义（P＞0.05）。T0时，4组患者血流动力学参数及SpO2比较，差异均无统计学差异（P＞0.05）。与T0时比较，4组患者SBP在T2时显著降低，N1组在T3、T4时显著降低，N2组在T3时显著降低，差异均有统计学意义（P＜0.05）；4组患者DBP在T2时显著降低，N1组在T3～T5时显著降低，N2组在T3时显著降低，差异均有统计学意义（P＜0.05）；P组患者在T3时HR显著降低，N3组在T5时显著降低，差异均有统计学意义（P＜0.05）；4组患者SpO2在T2时显著降低，N3组在T3时显著降低，差异均有统计学意义（P＜0.05）；N3组患者T1时SpO2显著低于P组，在T2时显著低于其余各组，在T3时显著低于P组和N1组，差异均有统计学意义（P＜0.05）。与P组比较，N2、N3组患者丙泊酚诱导剂量、总剂量、单位时间剂量及NRS评分均显著降低；N1、N2和N3组麻醉苏醒时间均显著缩短，差异均有统计学意义（P＜0.05）。与N1组比较，N2、N3组丙泊酚诱导剂量、总剂量、单位时间剂量和NRS评分均显著降低，麻醉苏醒时间显著缩短，差异均有统计学意义（P＜0.05）。与N2组比较，N3组丙泊酚诱导剂量、总剂量均显著降低，差异均有统计学意义（P＜0.05）。与P组比较，N3组患者头晕发生率显著增加；与P、N1和N2组比较，N3组患者低氧血症发生率显著增加，差异均有统计学意义（P＜0.05）。结论：0.10 mg/kg的纳布啡联合丙泊酚用于宫腔镜手术既能达到良好的麻醉和镇痛效果，又具有较高的安全性。 |
| ABSTRACT： | OBJECTIVE： To investigate effects of different doses of nalbuphine combined with propofol on anesthesia and analgesic effect of patients underwent hysteroscopic surgery. METHODS： A total of 120 inpatients undergoing painless hysteroscopic surgery were selected as research objects during Feb.-Nov. 2016. They were divided into group P， N1， N2， N3 according to random number table， with 30 cases in each group. Routine preoperative preparation was conducted in 4 groups. Group N1， N2， N3 were given Nalbuphine hydrochloride injection 0.05， 0.10， 0.15 mg/kg slowly， iv， within 1-2 min. After 3 min of injection， 4 groups were given 2％ Lidocaine hydrochloride injection 2 mL， iv+ Propofol injection 1 mg/kg，iv（40 mg/10 s）， and then injected with Propofol injection （10 mg/10 s） slowly until the patient’s eyelash reflex disappeared and no response was aroused. During surgery， Propofol injection was infused with micro pump at 6 mg/（kg·h） to maintain anesthesia until the end of operation. The levels of hemodynamic parameters （SBP， DBP， HR） and SpO2 of 4 groups were observed after admission to operating room （T0）， before propofol infusion （T1）， immediately after propofol infusion （T2）， during uterine cervical distension （T3）， at the end of surgery （T4） and during anesthesia recovery （T5）， respectively. The induction dose， maintenance dose， total dose， total dosing time and unit time dose of propofol， anesthesia recovery time and NRS scores after anesthesia recovery of patients were also observed in 4 groups. The occurrence of ADR was recorded during operation and anesthesia recovery. RESULTS： There was no statistical significance in maintenance dose and total dosing time of propofol， the incidence of body motion reaction， hypotension， sinus bradycardia， nausea and vomiting among 4 groups （P＞0.05）. At T0， there was no statistical significance in hemodynamic parameters or SpO2 among 4 groups （P＞0.05）. Compared to T0， SBP of 4 groups were decreased significantly at T2， that of group N1 was decreased significantly at T3-T4， and that of group N2 was decreased significantly at T3， with statistical significance （P＜0.05）. DBP of 4 groups were decreased significantly at T2， that of group N1 was decreased significantly at T3-T5， and that of group N2 was decreased significantly at T3， with statistical significance （P＜0.05）. HR of group P was decreased significantly at T3， and that of group N3 was decreased significantly at T5， with statistical significance （P＜0.05）. SpO2 of 4 groups were decreased significantly at T2， and that of group N3 was decreased significantly at T3， with statistical significance （P＜0.05）. SpO2 of group N3 at T1 was significantly lower than that of group P； at T2， it was significantly lower than other groups； at T3， it was significantly lower than group P and N1， with statistical significance （P＜0.05）. Compared to group P， induction dose， total dose and unit time dose of propofol， NRS scores of patients were significantly decreased in group N2 and N3； the anesthesia recovery time of group N1， N2， N3 were shortened significantly， with statistical significance （P＜0.05）. Compared with group N1， induction dose， total dose and unit time dose of propofol， NRS scores were significantly decreased in group N2 and N3， and anesthesia recovery time of them were shortened significantly， with statistical significance （P＜0.05）. Compared to group N2， induction dose and total dose of propofol were decreased signigficantly in group N3， with statistical significance （P＜0.05）. Compared with group P， the incidence of dizziness was increased significantly in group N3； compared with group P， N1， N2， the incidence of hypoxemia was increased significantly in group N3， with statistical significance （P＜0.05）. CONCLUSIONS： Nalbuphine 0.10 mg/kg combined with propofol for hysteroscopic surgery can achieve good anesthesia and analgesic effect with high safety. |
| 期刊： | 2017年第28卷第35期 |
| 作者： | 初阳，孙刚 |
| AUTHORS： | CHU Yang，SUN Gang |
| 关键字： | 纳布啡；丙泊酚；宫腔镜手术；麻醉；镇痛 |
| KEYWORDS： | Nalbuphine； Propofol； Hysteroscopic surgery； Anesthesia； Analgesic |
| 阅读数： | 286 次 |
| 本月下载数： | 1 次 |
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