纳布啡联合右美托咪定用于乳腺癌切口局部浸润镇痛的临床研究

EFFICACY OF NALBUPHIN COMBINED WITH DEXMEDETOMIDINE FOR LOCAL INFILTRATION ANALGESIA AFTER BREAST CANCER

摘要:

目的：评价纳布啡联合右美托咪定作为罗哌卡因佐剂用于乳腺癌术后切口局部浸润的临床效果。方法：选择本院2018年9至2018年12月行乳腺癌改良根治术的成年女性患者46例，采用计算机随机数字表法随机分为两组，每组23例：ND组（右美托咪定1μg/kg+纳布啡10mg+0.375%罗哌卡因共20ml）和C组（0.375%罗哌卡因20ml）。观察两组患者术后2h, 4h, 8h, 12h, 24h活动时的数字等级疼痛评分（Numerical rating scale, NRS）和Ramsay镇静评分及术后24h补救镇痛药（吗啡）消耗总量，并记录患者恶心呕吐、心动过缓、低血压和伤口感染等不良反应的发生情况。结果：术后24h的吗啡消耗量和术后2h, 4h, 8h, 12h, 24h活动时的NRS评分，ND组均显著低于C组，差异均具有统计学意义（P < 0.05）；术后2h,4h, 8h ND组的Ramsay镇静评分高于C组，差异有统计学意义（P < 0.05），但术后12h和24h两组患者的Ramsay镇静评分差异无统计学意义；不良反应两组间差异无统计学意义。 结论：纳布啡联合右美托咪定作为罗哌卡因佐剂用于乳腺癌术后切口局部浸润，有效解决了单用局麻药疗效的局限性，减少了术后阿片类药物使用，不良反应少，能够为患者提供更为安全和有效的术后镇痛。

Abstract:

Abstract Objective: The study aimed to observe the analgesic effect of nalbuphine and dexmedetomidine, which as adjuvant of ropivacaine on local infiltration of incision after breast cancer surgery. Methods: Forty-six female patients underwent modified radical mastectomy of breast cancer were randomly divided into two groups: ND group (20 ml: dexmedetomidine 1μg/kg + nalbuphine 10 mg + 0.375% ropivacaine) and C group (20 ml 0.375% ropivacaine). The activity NRS (numerical rating scale) pain score and Ramsay sedation score were observed at 2 hours, 4 hours, 8 hours, 12 hours, 24 hours after surgery. Both consumption of remedial analgesics (morphine) and adverse reactions such as nausea and vomiting, bradycardia, hypotension and wound infection in 24 hours after surgery were recorded. Results: Morphine consumption in 24 hours and the movement NRS scores at 2 hours, 4 hours, 8 hours, 12 hours and 24 hours after surgery were significantly lower in ND group (P < 0.05); Ramsay scores in ND group at 2 hours, 4 hours and 8 hours after surgery were significantly higher in ND group (P < 0.05). But, there were no statistical differences in Ramsay sedation score between the two groups at 12 and 24 hours after surgery. There were also no significant differences in adverse reactions between the two groups. Conclusion: Nalbuphine combined with dexmedetomidine as adjuvant of ropivacaine for local infiltration of incision after breast cancer surgery can effectively improve the limitation in postoperative analgesia only with ropivacaine. As well reduce the use of opioids after surgery with fewer adverse effects. This method can provide more effective postoperative analgesia and comfort for patients.