2019 年第 5 期 第 14 卷

纳布啡复合丙泊酚泵注麻醉对肠道经内镜黏膜下剥离术患者血流动力学和应激反应的影响

Effect of nalbuphine combined with propofol anesthesia on hemodynamics and stress response in patients undergoing intestinal endoscopic submucosal dissection

作者：陆志强李文媛陈惠裕

英文作者：

单位：210011南京医科大学第二附属医院麻醉科

英文单位：

关键词：经内镜黏膜下剥离术；纳布啡；丙泊酚；血流动力学；应激反应

英文关键词：

• 摘要：

• 【摘要】目的    探讨纳布啡复合丙泊酚泵注麻醉对肠道经内镜黏膜下剥离术（ESD）患者血流动力学和应激反应的影响。方法    选取2017年9—12月南京医科大学第二附属医院收治的择期行肠道ESD患者200例，采用随机数字表法将患者分为观察组和对照组，各100例。对照组采取舒芬太尼复合丙泊酚泵注麻醉，观察组采取纳布啡复合丙泊酚泵注麻醉。比较2组患者麻醉前5 min（T0）、麻醉开始时（T1）、手术开始5 min（T2）、手术开始30 min（T3）及术毕拔管时(T4)的心率、收缩压、舒张压、脉搏血氧饱和度（SpO2）等血流动力学指标及去甲肾上腺素（NE）、皮质醇、血糖水平等应激反应指标的变化情况。记录2组患者丙泊酚用量、麻醉唤醒时间、完全苏醒时间、术后疼痛视觉模拟量表评分及麻醉后不良反应发生情况。结果    与T0时点相比，2组患者T1～T3时点心率、收缩压、舒张压以及SpO2均有所降低，观察组T1～T3时点的SpO2高于对照组，差异均有统计学意义(均P＜0.05)。与T0时点相比，2组患者T1～T4时点的NE、皮质醇、血糖水平均明显升高，且观察组T1～T4时点的NE、皮质醇、血糖水平均低于对照组，差异均有统计学意义(均P＜0.05)。2组患者丙泊酚用量、麻醉唤醒时间、完全苏醒时间和术后疼痛视觉模拟量表评分比较，差异均无统计学意义（均P＞0.05）。观察组呛咳、呼吸抑制及恶心呕吐发生率均低于对照组［1.0%（1/100）比8.0%（8/100）、1.0%（1/100）比21.0%（21/100）、7.0%（7/100）比27.0%（27/100）］，差异均有统计学意义(均P＜0.05)。结论    肠道ESD患者应用纳布啡复合丙泊酚泵注麻醉，对血流动力学和应激反应的影响较小，不良反应少，是一种相对安全有效的麻醉配伍方法。

• 【Abstract】Objective    To investigate the effect of nalbuphine combined with propofol anesthesia on hemodynamics and stress response in patients undergoing intestinal endoscopic mucosal dissection(ESD). Methods    From September to December 2017, 200 patients undergoing intestinal ESD in the Second Affiliated Hospital of Nanjing Medical University were randomly divided into observation group and control group, with 100 patients in each group. The control group had sufentanil combined with propofol anesthesia. The observation group had nalbuphine combined with propofol anesthesia. Heart rate, systolic blood pressure, diastolic blood pressure, pulse oxygen saturation（SpO2）, levels of noradrenaline, cortisol and blood glucose were analyzed 5 min before anesthesia(T0), at the beginning of anesthesia(T1), 5 min during operation(T2), 30 min during operation(T3) and during extubation(T4). Dosage of propofol, postanesthetic arousal time, waking time, Visual Analogue Scale score of pain and adverse reactions were analyzed. Results    At T1-T3, heart rate, systolic blood pressure, diastolic blood pressure and SpO2 significantly decreased in both groups compared to those at T0; SpO2 in observation group was significantly higher than that in control group(all P＜0.05). At T1-T4, levels of noradrenaline, cortisol and blood glucose significantly increased in both groups and the levels in observation group were significantly lower than those in control group(all P＜0.05). There was no significant difference of propofol dosage, postanesthesia arousal time, waking time and pain score between groups(P＞0.05). Incidences of cough, respiratory depression, postoperative nausea and vomiting in observation group were lower than those in control group［1.0%（1/100） vs 8.0%（8/100）, 1.0%（1/100） vs 21.0%（21/100）, 7.0%（7/100） vs 27.0%（27/100）］(all P＜0.05). Conclusions    Intravenous anesthesia with nalbuphine combined with propofol pump has few effect on hemodynamics, stress response and few adverse reactions in patients with ESD. It is a safe and effective method of anesthesia compatibility.