纳布啡作为局麻药佐剂用于老年患者全髋关节置换术后神经阻滞镇痛的临床研究
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河南省医学科技攻关联合共建项目(LHGJ20220656);


Clinical study of Nalbuphine as local anesthetic adjuvant for nerve block analgesia in elderly patients after total hip arthroplasty
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    摘要:

    目的:探讨不同剂量纳布啡复合罗哌卡因行超声引导下腹股沟上髂筋膜间隙阻滞(U-SFICB)对老年患者全髋关节置换术(THA)后镇痛效果的影响。方法:选取101例拟在全身麻醉下行单侧THA的老年患者为研究对象,按照麻醉方案不同分为:100 mg罗哌卡因+生理盐水组(R组,n=26)、100 mg罗哌卡因+10 mg纳布啡组(LN组,n=25)、100 mg罗哌卡因+15 mg纳布啡组(MN组,n=25)、100 mg罗哌卡因+20 mg纳布啡组(HN组,n=25),各组均用0.9%氯化钠注射液稀释至30 mL。各组患者均在麻醉恢复室(PACU)进行U-SFICB,术后均采用舒芬太尼进行患者自控静脉镇痛。比较各组患者术后4、8、12、24及48 h的静息和运动状态下的数字分级评分法(NRS)评分;比较各组患者术前12 h、术后12、24 h的白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、白细胞介素10(IL-10)水平;比较各组患者术后镇痛泵首次启动时间及48 h舒芬太尼使用量;比较各组患者术后早期恢复情况,并记录术后48 h镇痛相关不良反应发生情况。结果:术后12、24 h,与R组、LN组相比,MN组及HN组NRS评分更低(P<0.05);各时间点IL-6、TNF-α水平更低(P<0.05);IL-10水平更高(P<0.05);术后镇痛泵的启动时间更长(P<0.05);术后48 h舒芬太尼使用量及镇痛泵按压次数更少(P<0.05)。与R组、LN组、HN组相比,MN组术后首次肛门排气时间及下床时间均最短(P<0.05);术后48 h不良反应总发生率最低(P<0.05)。结论:15 mg纳布啡复合罗哌卡因可显著延长老年患者THA术后U-SFICB的镇痛持续时间,且术后首次肛门排气时间和首次下床活动时间最短,术后48 h内不良反应的发生率最低,可在临床推广和应用。

    Abstract:

    Objective:To observe the effect of ultrasound-guided suprainguinal fascia iliaca compartment block(U-SFICB)with ropivacaine combined with different doses of nalbuphine on analgesia in elderly patients after total hip arthroplasty(THA).Methods:101 elderly patients with unilateral THA under general anesthesia were divided into four groups according to different anesthesia regimens:100 mg ropivacaine+normal saline group(R group,n=26),100 mg ropivacaine+10 mg nal-buphine group(LN group,n=25),and 100 mg ropivacaine+15 mg nalbuphine group(MN group,n=25),and 100 mg ropiv-acaine+20mg nalbuphine group(HN group,n=25),all were diluted to 30 mL with 0.9%sodium chloride injection.All four groups underwent U-SFICB in the post-anesthesia care unit(PACU),and sufentanil was used for patient-controlled intravenous analgesia after surgery.Comparison between groups of postoperative 4,8,12,24,and 48 h of resting and motion state of Numer-ical rating scale(NRS).Each group received 12 h preoperatively,12 and 24 h postoperatively,Interleukin 6(IL-6),Tumor nec-rosis factor-α(TNF-α),Interleukin 10(IL-10)concentration,the first start time of postoperative analgesia pump and 48 h of sufentanil use in each group,the early postoperative recovery of each group,and the occurrence of analgesia related adverse reac-tions 48 h after surgery were compared between groups.Results:Compared with R group and LN group,NRS score in MN and HN group was decreased at all time points(P<0.05),IL-6 and TNF-α concentrations were decreased at all time points(P<0.05),IL-10 concentrations were increased at all time points(P<0.05),and the start-up time of postoperative analgesia pump was significantly extended(P<0.05).The amount of sufentanil was significantly decreased 48 hours after operation(P<0.05).Compared with R group,LN group and HN group,the time of first anal exhaust and getting out of bed in MN group were significantly shortened(P<0.05).The incidence of adverse reactions was significantly decreased 48 h after operation(P<0.05).Compared with HN group,the start-up time of postoperative analgesic pump in MN group was significantly short-ened(P<0.05),and the overall incidence of adverse reactions was the lowest at 48 h after surgery(P<0.05).Conclusion:15 mg nalbuphine combined with ropivacaine can significantly prolong the duration of U-SFICB analgesia after THA in elderly pa-tients,and the first postoperative anal exhaust time and the first time of getting out of bed activity are the shortest,and the inci-dence of adverse reactions is the lowest within 48 hours after surgery,which can be clinically promoted and applied.

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王华娟;刘骐毓;刘静;李明明;宋满;李凤娟;郑孝振;.纳布啡作为局麻药佐剂用于老年患者全髋关节置换术后神经阻滞镇痛的临床研究[J].川北医学院学报,2025,40(10):1253-1258.

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  • 在线发布日期: 2025-11-03
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