纳布啡清醒镇静镇痛在脊柱微创手术中的应用

纳布啡清醒镇静镇痛在脊柱微创手术中的应用

摘要：目的探讨纳布啡清醒镇静镇痛麻醉在脊柱微创手术中应用的可行性。方法选择我院择期行椎间孔镜下椎间盘髓核摘除术及经皮椎体成形术患者60例，随机分成两组，各30例。实验组手术前予静脉注射盐酸纳布啡;对照组手术前予静脉注射生理盐水，兩组患者均予1%利多卡因局部浸润麻醉后开始手术，术中若患者NRS评分≥6分，则予芬太尼50～100 μg/次进行补偿性镇痛。比较两组患者术中各时点的NRS评分、改良OAA/S评分、MAP、HR、SpO2、芬太尼用量、麻醉相关不良反应、患者和术者对麻醉的满意度等。结果实验组T2、T3时刻NRS评分，T1时刻的OAA/S评分低于对照组（P＜0.01）;实验组T1、T2、T3时刻MAP、HR均低于对照组（P＜0.05）;对照组T2、T3时刻SpO2低于实验组;实验组T2、T3时刻芬太尼用量小于对照组（P＜0.01）;实验组恶心呕吐、呼吸抑制的发生率低于对照组（P＜0.05）;两组间头晕、瘙痒、尿潴留发生率比较，差异无统计学意义（P>0.05）;实验组患者对麻醉的满意度评价高于对照组（P＜0.01）;术者对实验组麻醉的满意度高于对照组（P＜0.01）。结论纳布啡清醒镇静镇痛用于脊柱微创手术麻醉，镇痛效果良好，心血管稳定性更好，不良反应较小，患者、术者对麻醉满意度高。

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