盐酸纳布啡联合右美托咪定对腹腔镜减重手术患者术后恢复质量及疼痛的影响

doi:10.3969/j.issn.1006-5725.2024.07.020

Abstract

Abstract:

Objective To investigate the effects of nalbuphine combined with dexmedetomidine on postoperative recovery quality and pain in patients who undergoing laparoscopic bariatric surgery. Methods A total of 169 patients who underwent laparoscopic bariatric surgery at our hospital were included and divided into control group （group C）， nalbuphine group （group N）， dexmedetomidine group （group D）， and nalbuphine combined with dexmedetomidine group （group ND） using randomised numerical table method. Group C received intravenous injection of saline， group N and group ND received intravenous injection of nalbuphine before the end of the surgery， and group D and group ND received pumping of dexmedetomidine before anesthesia induction and during surgery. Compare the postoperative recovery quality score （QoR?40）， hemodynamics at different time points， visual analogue scale score （VAS）， sedation?agitation scale （SAS）， first time out of bed activity and exhaust time， and incidence of nausea and vomiting among four groups. Results The postoperative QoR?40 scores of patients in group ND were better than those in group C and group N （P < 0.05）， and the QoR?40 scores in group D were better than those in group C （P < 0.05）. MAP and HR were more stable during the awakening period in group ND and group D （P < 0.05）. Compared with group C， patients in all three groups had lower VAS scores and SAS scores （P < 0.05） and consumed less remedial analgesic medication（P < 0.05）. In terms of adverse reactions， the incidence of postoperative nausea， vomiting and coughing in the group ND was lower than that in the group C （P < 0.05）. Conclusion The combination of nalbuphine and dexmedetomidine could improve the quality of postoperative recovery and pain in patients undergoing laparoscopic bariatric surgery， reduce hemodynamic fluctuations during the patients′ recovery period， reduce the incidence of nausea and vomiting， and improve the patients′ prognosis.

Key words: dexmedetomidine, nalbuphine, bariatric surgery, recovery quality, hemodynamics

CLC Number:

R614

Jinyan FAN,Lili CHEN,Su LIU,Chuanwu ZHANG,Zhen′ang MENG,Guanglei. WANG. Effect of nalbuphine hydrochloride combined with dexmedetomidine on post⁃operative recovery quality and pain in patients undergoing laparoscopic bariatric surgery[J]. The Journal of Practical Medicine, 2024, 40(7): 996-1001.

Figures/Tables 6

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References 21

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项目	C组（n = 41）	N组（n = 40）	D组（n = 39）	ND组（n = 41）	P值
性别（男/女，例）	13/28	13/27	15/24	12/29	0.845
年龄（x ± s，岁）	32.2±7.3	32.3±7.6	32.8±6.0	30.8±7.7	0.610
BMI（x ± s，kg/m²）	39.7±4.6	40.5±7.0	41.4±7.1	41.7±5.5	0.431
ASA分级（Ⅱ/Ⅲ，例）	28/13	26/14	23/16	27/14	0.846
高血压［例（%）］	18（43.9）	14（35.0）	17（43.6）	14（34.1）	0.698
糖尿病［例（%）］	16（39.0）	13（32.5）	15（38.5）	12（29.3）	0.753
吸烟［例（%）］	6（14.6）	7（17.5）	10（25.6）	6（14.6）	0.536
OSAHS［例（%）］	23（56.1）	19（47.5）	18（46.2）	22（53.7）	0.776
袖状胃/胃旁路（例）	27/14	26/14	27/12	30/11	0.854
手术时间［M（P₂₅，P₇₅），min］	95（70，130）	89（69，129）	86（76，122）	92（75，130）	0.849

项目	C组（n = 41）	N组（n = 40）	D组（n = 39）	ND组（n = 41）	P值
P值	< 0.001	< 0.001	< 0.001	< 0.001
术前	181.2 ± 10.4	180.9 ± 8.8	179.6 ± 11.5	178.1 ± 10.8	0.550
POD1	154.8 ± 14.4^△	159.5 ± 14.4^△	164.3 ± 16.2^*△	169.7 ± 11.3^*#△	< 0.001
POD2	163.0 ± 11.9^△▲	166.7 ± 12.5^△▲	168.3 ± 12.0^*△▲	172.6 ± 10.2^*#△▲	0.001

项目	T1	T2	T3	T4	T5
MAP（mmHg）
C组	88.5 ± 8.0	100.8 ± 7.3^△	109.1 ± 5.8^△	101.6 ± 6.7^△	95.7 ± 8.6^△
N组	89.3 ± 7.8	98.2 ± 7.3^△	106.4 ± 7.4^△	98.4 ± 8.6^*△	93.9 ± 8.2^△
D组	85.6 ± 7.6	93.0 ± 7.6^*#△	98.5 ± 8.0^*#△	93.3 ± 7.3^*#△	91.0 ± 6.2^*△
ND组	86.3 ± 10.4	93.1 ± 10.3^*#△	96.8 ± 9.1^*#△	92.5 ± 7.9^*#△	90.4 ± 8.1^*△
HR（次/min）
C组	67.2 ± 12.2	83.0 ± 9.9^△	93.3 ± 10.9^△	81.4 ± 9.5^△	77.1 ± 8.0^△
N组	65.8 ± 10.5	79.5 ± 9.3^△	87.8 ± 9.4^△	80.1 ± 8.3^△	76.7 ± 8.2^△
D组	66.3 ± 9.3	74.7 ± 8.7^*#△	80.8 ± 9.2^*#△	74.3 ± 8.4^*#△	73.1 ± 6.6^*#△
ND组	64.9 ± 10.1	72.7 ± 9.1^*#△	76.7 ± 8.8^*#△	73.8 ± 8.6^*#△	72.1 ± 6.6^*#△

项目	C组（n = 41）	N组（n = 40）	D组（n = 39）	ND组（n = 41）	P值
丙泊酚（mg）	354.48 ± 121.87	366.60 ± 104.50	288.67 ± 81.79^*#	282.04 ± 75.12^*#	< 0.001
瑞芬太尼（mg）	2.10 ± 0.55	2.01 ± 0.62	1.77 ± 0.50^*	1.69 ± 0.46^*#	0.002
拔管时间（min）	10.73 ± 2.60	11.15 ± 2.51	11.72 ± 2.50	12.10 ± 3.07	0.107
SAS评分（分）	4.56 ± 0.84	3.98 ± 0.73^*	3.85 ± 0.96^*	3.61 ± 1.00^*	< 0.001
地佐辛（mg）	13.66 ± 5.07	8.65 ± 4.44^*	9.74 ± 4.82^*	7.07 ± 4.19^*	< 0.001
首次下床活动时间（h）	11.90 ± 3.51	13.38 ± 3.72	12.48 ± 3.09	13.16 ± 4.07	0.246
首次排气时间（h）	26.40 ± 5.80	26.05 ± 3.75	24.79 ± 4.35	25.72 ± 4.83	0.477
出院时间［M（P₂₅，P₇₅），d］	1.9（1.8，2.0）	1.9（1.7，2.1）	1.9（1.8，2.2）	1.9（1.8，2.1）	0.849

时间	C组（n = 41）	N组（n = 40）	D组（n = 39）	ND组（n = 41）	P值
P值	< 0.001	< 0.001	< 0.001	< 0.001
术后即刻	1.98 ± 1.49	1.70 ± 1.29	1.64 ± 1.22	1.61 ± 1.28	0.633
术后2 h	3.85 ± 1.46^#	2.60 ± 1.39^*#	2.62 ± 1.46^*#	2.37 ± 1.22^*#	< 0.001
术后6 h	4.37 ± 1.39^#	3.43 ± 1.50^*#	3.31 ± 1.54^*#	2.95 ± 1.41^*#	< 0.001
术后12 h	3.15 ± 1.01^#	2.75 ± 1.13^#	2.64 ± 1.06^*#	2.41 ± 1.38^*#	0.027
术后24 h	2.29 ± 1.06	1.98 ± 0.92	2.08 ± 1.37	1.83 ± 1.22	0.274
术后48 h	1.46 ± 1.16	1.35 ± 0.86	1.28 ± 0.97	1.17 ± 0.92^#	0.613

Effect of nalbuphine hydrochloride combined with dexmedetomidine on post⁃operative recovery quality and pain in patients undergoing laparoscopic bariatric surgery

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项目	C组（n = 41）	N组（n = 40）	D组（n = 39）	ND组（n = 41）	P值
低血压	7（17.1）	9（22.5）	12（30.8）	13（31.7）	0.373
心动过缓	1（2.4）	1（2.5）	3（7.7）	4（9.8）	0.396
呛咳	20（48.8）	8（20.0）^?	8（20.5）^?	6（14.6）^?	0.001
恶心	24（58.5）	21（52.5）	11（28.2）^?	10（24.4）^?	0.002
呕吐	19（46.3）	18（45.0）	9（23.1）	7（17.1）^?#	0.006
发热	1（2.4）	0（0.0）	2（5.1）	1（2.4）	0.470
低氧血症	4（9.8）	7（17.5）	4（10.3）	5（12.2）	0.743

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