纳布啡对胸腔镜肺叶切除术患者围手术期的镇痛和抗炎作用。

Nalbuphine analgesic and anti-inflammatory effects on patients undergoing thoracoscopic lobectomy during the perioperative period.

作者信息

Zhang Yang, Jiang Qi, Li Tao

机构信息

Department of Anesthesiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China.

Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China.

出版信息

Exp Ther Med. 2017 Oct;14(4):3117-3121. doi: 10.3892/etm.2017.4920. Epub 2017 Aug 10.

Abstract

This study sought to investigate the analgesic effects of nalbuphine on patients undergoing thoracoscopic lobectomy during the perioperative period, as well as its effects on inflammatory cytokines. We selected 92 patients with early lung cancer who were admitted to Xiangyang No. 1 People's Hospital between January 2016 and December 2016. The patients were randomly divided into control and observation groups (n=46 each). All patients underwent thoracoscopic lobectomy, with those in the observation group receiving intravenous nalbuphine hydrochloride prior to induction (the control group received saline). Intraoperative blood loss, operation time and anesthetic dosages were compared between groups. The analgesic effects during the perioperative period were compared using a visual analogue scale. The adverse effects of anesthetics (nausea, vomiting, dizziness and drowsiness) were compared between the two groups. Finally, serum inflammatory cytokine [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and IL-10] levels were measured using ELISA at 1, 3, 5 and 7 days after operation. There were no significant differences in intraoperative blood loss and operation time between the two groups (p>0.05). However, dosages of propofol and remifentanil used were lower in the observation group than in the control group (p<0.05), and the effective rate of postoperative analgesia in the observation group was significantly higher than that in the control group (p<0.05). The degree of postoperative pain in both groups were lower than preoperative rates (p<0.05), while the incidence of adverse reactions in the observation group was significantly lower than in the control group (p<0.05). Finally, TNF-α, IL-6 and IL-10 levels were significantly lower in the observation group relative to the control group at 1, 3, 5 and 7 days after operation (p<0.05). Therefore, nalbuphine has a significant analgesic effect during thoracoscopic lobectomy. The application of nalbuphine can reduce the incidence of adverse reactions, reduce postoperative inflammatory responses, and promote rapid patient recovery, thus demonstrating the clinical value of nalbuphine.

摘要

本研究旨在探讨纳布啡对胸腔镜肺叶切除术患者围手术期的镇痛效果及其对炎性细胞因子的影响。我们选取了2016年1月至2016年12月期间入住襄阳市第一人民医院的92例早期肺癌患者。将患者随机分为对照组和观察组(每组n = 46)。所有患者均接受胸腔镜肺叶切除术,观察组患者在诱导前静脉注射盐酸纳布啡(对照组注射生理盐水)。比较两组患者术中出血量、手术时间和麻醉剂量。采用视觉模拟评分法比较围手术期的镇痛效果。比较两组麻醉不良反应(恶心、呕吐、头晕和嗜睡)。最后,在术后1、3、5和7天采用酶联免疫吸附测定法检测血清炎性细胞因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和IL-10]水平。两组患者术中出血量和手术时间差异无统计学意义(p>0.05)。然而,观察组丙泊酚和瑞芬太尼的用量低于对照组(p<0.05),观察组术后镇痛有效率显著高于对照组(p<0.05)。两组术后疼痛程度均低于术前(p<0.05),而观察组不良反应发生率显著低于对照组(p<0.05)。最后,术后1、3、5和7天观察组TNF-α、IL-6和IL-10水平相对于对照组显著降低(p<0.05)。因此,纳布啡在胸腔镜肺叶切除术中具有显著的镇痛效果。纳布啡的应用可降低不良反应发生率,减轻术后炎症反应,促进患者快速康复,从而体现出纳布啡的临床价值。

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