术前应用纳布啡联合氟比洛芬酯镇痛对肝硬化失代偿期患者痛觉及血小板活性的影响

doi:10.13481/j.1671-587x.20190332

摘要/Abstract

摘要： 目的：观察术前应用纳布啡联合氟比洛芬酯镇痛对肝硬化失代偿期患者血小板活性效率指标的影响，探讨其对肝硬化失代偿期患者的镇痛质量。方法：120例肝硬化失代偿期患者随机分为联合组（40例，给予纳布啡和氟比洛芬酯超前镇痛）、纳布啡组（40例，单用纳布啡超前镇痛）和氟比洛芬酯组（40例，单用氟比洛芬酯超前镇痛）。3组患者术后均给予舒芬太尼静脉自控镇痛泵（PCIA）。术后12和24 h分别观察3组患者疼痛视觉模拟评分（VAS评分）、PCIA有效按压次数、舒芬太尼剂量、Ramsay评分、血栓弹力图（TEG）各参数（R值、K值、α角、MA值和CI值）、花生四烯酸诱导血小板最大聚集率（MARAA）、β-内啡肽（β-EP）水平、苏醒时间和苏醒期躁动发生率。结果：术后12和24 h联合组患者VAS评分、PCIA有效按压次数、舒芬太尼剂量和β-EP水平均低于其他2组（P<0.05），而纳布啡组与氟比洛芬酯组患者上述指标比较差异无统计学意义（P>0.05）；3组患者术后12和24 h时Ramsay评分比较差异均无统计学意义（P>0.05）。与纳布啡组比较，联合组和氟比洛芬酯组患者术后12和24 h时R值和K值均明显升高（P<0.05），而α角、MA值、CI值和MARAA明显降低（P<0.05）。3组患者苏醒时间比较差异无统计学意义（F=2.054，P=0.102）。联合组患者苏醒期躁动发生率最低（F=5.624，P=0.001），纳布啡组和氟比洛芬酯组患者苏醒期躁动发生率比较差异无统计学意义（χ²=3.020，P=0.091）。结论：肝硬化失代偿期患者术前应用纳布啡联合氟比洛芬酯超前镇痛能改善术后镇痛质量，对血小板活性效率的抑制作用不明显。

关键词: 肝硬化失代偿期, 纳布啡, 氟比洛芬酯, 超前镇痛, 血小板

Abstract: Objective:To observe the influence of preemptive analgesia by nalbuphine combined with flurbiprofen in the platelet activity indexes of the patients with decompensated cirrhosis, and to explore its quality of analgesia in the patients with decompensated cirrhosis. Methods:A total of 120 patients with decompensated cirrhosis were randomly divided into combination group (40 cases, given nalbuphine combined with flurbiprofen before anesthesia), nalbuphine group (40 cases, given nalbuphine before anesthesia) and flurbiprofen group (40 cases, given flurbiprofen before anesthesia). The postoperative patient-controlled intravenous analgesia (PCIA) was carried out with sufentanil in all the patients. The indexes of visual analog score (VAS), PCIA compression number, sufentanil consumption, Ramsay score,thrombelastogram (TEG) indexes (R value, K value, α angle, MA value and CI value) and the maximum aggregation rate by arachidonic acid (MARAA) and β-endorphin (β-EP) level,recovery time, and agitation occurrence rate of the patients in various groups were recorded 12 h and 24 h after operation. Results:The indexes of VAS, PCIA compression number, sufentanil consumption and β-EP level of the patients in combination group were lower than those in the other groups 12 and 24 h after operation (P<0.05), but the differences of the above indexes of the patients in nalbuphine group and flurbiprofen group were not significant (P>0.05). The Ramsay scores of the patients in three groups had no differences at 12 and 24 h after operation (P>0.05). Compared with nalbuphine group, the R values and K values of the patients in combination group and flurbiprofen group at 12 and 24 h after operation were increased (P<0.05), and the α angle, MA values, CI values and MARAA of the patients in combination group and flurbiprofen group were decreased(P<0.05),but the above indexes of the patients in combination group and flurbiprofen group had no significant differences (P>0.05). The recovery time of the patients among three groups had no significant difference (F=2.054, P=0.102). The agitation occurrence rate during recovery period of the patients in case group was the highest (F=5.624, P=0.001), and there was no significant difference in the agitation occurrence rate during recovery period of the patiens between nalbuphine group and flurbiprofen group (χ²=3.020, P=0.091). Conclusion:Combination of nalbuphine and flurbiprofen in the patients with decompensated cirrhosis before analgesia can improve the quality of postoperative analgesia and can't inhibit the activity of platelet obviously.

Key words: decompensated cirrhosis, nalbuphine, flurbiprofen, preemptive analgesia, before analyesia platelet

中图分类号:

R575.2

冯海妹, 韦雪梅, 徐志新. 术前应用纳布啡联合氟比洛芬酯镇痛对肝硬化失代偿期患者痛觉及血小板活性的影响[J]. 吉林大学学报(医学版), 2019, 45(03): 661-666.

FENG Haimei, WEI Xuemei, XU Zhixin. Effects of preemptive analgesia by nalbuphine combined with flurbiprofen on pain and platelet activity in patients with decompensated cirrhosis[J]. Journal of Jilin University(Medicine Edition), 2019, 45(03): 661-666.

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