納布啡清醒鎮靜鎮痛在脊柱微創手術中的應用

吳健 張成豪 趙國軍

摘 ? 要：目的 ?探討納布啡清醒鎮靜鎮痛麻醉在脊柱微創手術中應用的可行性。方法 ?選擇我院擇期行椎間孔鏡下椎間盤髓核摘除術及經皮椎體成形術患者60例，隨機分成兩組，各30例。實驗組手術前予靜脈注射鹽酸納布啡;對照組手術前予靜脈注射生理鹽水，兩組患者均予1%利多卡因局部浸潤麻醉后開始手術，術中若患者NRS評分≥6分，則予芬太尼50～100 μg/次進行補償性鎮痛。比較兩組患者術中各時點的NRS評分、改良OAA/S評分、MAP、HR、SpO2、芬太尼用量、麻醉相關不良反應、患者和術者對麻醉的滿意度等。結果 ?實驗組T2、T3時刻NRS評分，T1時刻的OAA/S評分低于對照組（P<0.01）;實驗組T1、T2、T3時刻MAP、HR均低于對照組（P<0.05）;對照組T2、T3時刻SpO2低于實驗組;實驗組T2、T3時刻芬太尼用量小于對照組（P<0.01）;實驗組惡心嘔吐、呼吸抑制的發生率低于對照組（P<0.05）;兩組間頭暈、瘙癢、尿潴留發生率比較，差異無統計學意義（P>0.05）;實驗組患者對麻醉的滿意度評價高于對照組（P<0.01）;術者對實驗組麻醉的滿意度高于對照組（P<0.01）。結論 ?納布啡清醒鎮靜鎮痛用于脊柱微創手術麻醉，鎮痛效果良好，心血管穩定性更好，不良反應較小，患者、術者對麻醉滿意度高。

關鍵詞：納布啡;清醒鎮靜鎮痛;脊柱微創手術

中圖分類號：R614 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?文獻標識碼：A ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?DOI：10.3969/j.issn.1006-1959.2018.24.017

文章編號：1006-1959（2018）24-0067-03

Abstract：Objective ?To explore the feasibility of nalbuphine conscious sedative analgesia anesthesia in minimally invasive surgery of the spine. Methods ?60 patients with intervertebral disc nucleus pulposus and percutaneous vertebroplasty underwent elective intervertebral foramen were randomly divided into two groups， 30 cases each. The experimental group received intravenous nalbuphine hydrochloride before operation. The control group received intravenous saline before surgery. Both groups received 1% lidocaine local anesthesia and started surgery. If the patient had NRS score ≥6 points during surgery， Compensatory analgesia was given to fentanyl 50～100 μg/time. The NRS scores， modified OAA/S score， MAP， HR， SpO2， fentanyl dosage， anesthesia-related adverse reactions， and patient and surgeon satisfaction with anesthesia were compared between the two groups. Results ?The NRS scores at T2 and T3 in the experimental group were lower than those in the control group at the time of T1 （P<0.01）. The MAP and HR at the T1， T2 and T3 levels in the experimental group were lower than those in the control group （P<0.05）. The SpO2 at T2 and T3 was lower than that in the experimental group. The dose of fentanyl in the experimental group was lower than that in the control group at T2 ?and T3 （P<0.01）. The incidence of nausea and vomiting and respiratory depression in the experimental group was lower than that in the control group （P<0.05）. There was no significant difference in the incidence of dizziness， itching and urinary retention between the groups （P>0.05）. The satisfaction of the anesthesia in the experimental group was higher than that in the control group （P<0.01）. The surgeon was satisfied with the anesthesia of the experimental group. The degree was higher than the control group （P<0.01）. Conclusion ?Nalbuphine conscious sedation and analgesia is used for minimally invasive surgery of the spine. The analgesic effect is good， the cardiovascular stability is better， the adverse reactions are less， and the patients and surgeons have high satisfaction with anesthesia.

Key words：Nalbuphine;Conscious sedation and analgesia;Minimally invasive spinal surgery

近年來，微創脊柱外科取得了巨大的進步與發展，經皮椎間孔鏡技術（percutaneous transformational endoscopic discectomy， PTED）、經皮椎體成形術（percutaneous vertebroplasty， PVP）等一系列脊柱微創手術因其手術創傷小、出血少、恢復快等特點，在臨床中應用日漸廣泛[1]。清醒、鎮靜、鎮痛狀態，保證患者呼吸循環穩定，保證患者與術者進行正常交流是脊柱微創手術對麻醉提出的新要求[2]。鹽酸納布啡具有強效鎮痛、適度鎮靜、呼吸抑制作用輕微、心血管穩定性好、阿片類藥物相關副作用小等獨特的藥理特性[3]，是脊柱微創手術麻醉的理想藥物。本研究將探討納布啡清醒鎮靜鎮痛麻醉應用于脊柱微創手術的安全性和有效性，報道如下。

1資料與方法

1.1一般資料 ?賀州市中醫醫院2016年12月～2018年10月脊柱骨科擇期行椎間孔鏡下椎間盤髓核摘除術及經皮椎體成形術患者60例，年齡43～80歲，ASA分級：Ⅰ～Ⅱ級，無酒精、阿片類藥物依賴史?！?br>