Department of Anesthesiology, Wuhan No.1 Hospital, 430030 Wuhan, Hubei, China.
Ann Ital Chir. 2024;95(5):832-839. doi: 10.62713/aic.3357.
Laparoscopic cholecystectomy (LC) is a common surgical procedure for the removal of the gallbladder. Effective anesthesia is crucial for ensuring patient comfort and safety during LC. Dexmedetomidine, a selective α2-adrenergic agonist, is widely used as an adjunct to anesthesia due to its sedative and analgesic properties. Nalbuphine, a synthetic opioid analgesic, is also employed for pain management during various surgical procedures. This study aimed to determine the anesthesia effects of dexmedetomidine combined with nalbuphine on patients undergoing LC and its impact on their nutritional status.
The clinical records of 100 patients who underwent LC at Wuhan No.1 Hospital between January 2021 and January 2022 were analyzed retrospectively. Forty-six patients who received intravenous dexmedetomidine (0.4 µg/kg) were assigned to the control group, while fifty-four patients who received intravenous nalbuphine (0.2 mg/kg) and dexmedetomidine (0.4 µg/kg) were assigned to the study group. The outcomes compared between the two groups included heart rate (HR), mean arterial pressure (MAP), Riker sedation-agitation scale (RSAS) scores, visual analogue scale (VAS) scores, duration of operation, awakening time from anesthesia, extubation time, adverse reactions, and nutrition-related indicators before and after surgery.
There were no significant differences in MAP between the groups at the same time point (p > 0.05). However, at T1 and T3, the study group had significantly lower HR compared to the control group (p < 0.05), with no significant differences in HR at other time points (p > 0.05). The study group exhibited significantly lower RSAS scores compared to the control group (p < 0.01). No significant differences were observed between the groups in terms of duration of operation, awakening time from anesthesia, and extubation time (p > 0.05). At 6 hours post-operation, there were no significant differences in VAS scores between the groups (p > 0.05), but at 12, 24, and 48 hours post-operation, the study group had significantly lower VAS scores compared to the control group (p < 0.0001). No significant inter-group difference was observed in the total incidence of adverse reactions (p = 0.180). Additionally, one week after surgery, the study group exhibited significantly higher levels of albumin, prealbumin, transferrin, and total protein compared to the control group (p < 0.0001).
Dexmedetomidine combined with nalbuphine provides a superior anesthetic effect compared to dexmedetomidine alone in patients undergoing LC. This combination effectively controls hemodynamic fluctuations during the recovery period and reduces agitation without affecting the awakening time from anesthesia. These findings suggest that this combination is beneficial and worth promoting.
腹腔镜胆囊切除术（LC）是一种常见的胆囊切除手术。有效的麻醉对于确保患者在手术过程中的舒适和安全至关重要。右美托咪定是一种选择性α2-肾上腺素能激动剂，由于其具有镇静和镇痛作用，被广泛用作麻醉的辅助剂。纳布啡是一种合成阿片类镇痛药，也用于各种手术过程中的疼痛管理。本研究旨在确定右美托咪定联合纳布啡对接受 LC 患者的麻醉效果及其对其营养状况的影响。
回顾性分析 2021 年 1 月至 2022 年 1 月期间在武汉市第一医院接受 LC 的 100 例患者的临床记录。46 例接受静脉注射右美托咪定（0.4μg/kg）的患者被分配到对照组，而 54 例接受静脉注射纳布啡（0.2mg/kg）和右美托咪定（0.4μg/kg）的患者被分配到研究组。比较两组之间的结果包括心率（HR）、平均动脉压（MAP）、Riker 镇静-躁动量表（RSAS）评分、视觉模拟评分（VAS）、手术持续时间、麻醉苏醒时间、拔管时间、不良反应以及手术前后的营养相关指标。
两组在同一时间点的 MAP 无显著差异（p>0.05）。然而，在 T1 和 T3 时，研究组的 HR 明显低于对照组（p<0.05），其他时间点的 HR 无显著差异（p>0.05）。研究组的 RSAS 评分明显低于对照组（p<0.01）。两组的手术持续时间、麻醉苏醒时间和拔管时间无显著差异（p>0.05）。术后 6 小时，两组 VAS 评分无显著差异（p>0.05），但术后 12、24 和 48 小时，研究组的 VAS 评分明显低于对照组（p<0.0001）。两组不良反应总发生率无显著差异（p=0.180）。此外，术后一周，研究组的白蛋白、前白蛋白、转铁蛋白和总蛋白水平明显高于对照组（p<0.0001）。
与单独使用右美托咪定相比，右美托咪定联合纳布啡在接受 LC 的患者中提供了更好的麻醉效果。这种组合有效控制了恢复期的血流动力学波动，并减少了躁动，而不影响麻醉苏醒时间。这些发现表明这种组合是有益的，值得推广。
