腹腔镜胆囊切除术治疗胆囊息肉患者术后纳布啡多模式镇痛应用效果分析*

doi:10.3969/j.issn.1672-5069.2025.03.038

摘要/Abstract

摘要： 目的探讨腹腔镜胆囊切除术(LC)治疗胆囊息肉患者术后盐酸纳布啡多模式镇痛应用效果及对血清P物质(SP)和前列腺素E2(PGE2)水平的影响。方法 2020年11月～2024年3月我院收治的胆囊息肉患者78例,均接受择期LC手术治疗。在术后镇痛时,随机将患者分成两组,每组39例。所有患者均接受双侧腹横肌平面阻滞(TAP)联合静脉自控镇痛(PCIA)。对照组应用氟比洛芬酯注射液,观察组应用纳布啡。采用疼痛视觉模拟量表(VAS)和Ramsay镇静(RSS)评分,采用放射免疫分析法检测血清P物质(SP)和前列腺素E2(PGE2)水平。结果在术后1h、4h和12 h,观察组VAS评分分别为(3.7±0.7)分、(4.0±0.8)分和(4.3±0.9)分,均显著低于对照组【分别为(4.3±0.7)分、(4.6±0.9)分和(4.9±1.0)分,P＜0.05】;在术后1h、4h、12 h和24 h,观察组RSS评分分别为(2.4±0.5)分、(2.6±0.6)分、(2.9±0.6)分和(2.5±0.6)分,与对照组【分别为(2.5±0.6)分、(2.7±0.6)分、(3.0±0.7)分和(2.6±0.5)分】比,无显著性差异(P>0.05);在术后1h、4h和12 h,观察组血清SP水平分别为(0.9±0.2)μg/mL、(2.7±0.6)μg/mL和(4.3±1.0)μg/mL,均显著低于对照组【分别为(1.3±0.3)μg/mL、(4.4±1.1)μg/mL和(6.5±1.3)μg/mL,P＜0.05】,血清PEG2水平分别为(91.9±11.5)pg/mL、(265.3±29.6)pg/mL和(168.3±18.7)pg/mL,均显著低于对照组【分别为(108.8±12.7)pg/mL、(304.2±32.8)pg/mL和(183.2±20.6)pg/mL,P＜0.05】;术后,观察组首次肛门排气时间、恢复进食时间和拔除引流管时间分别为(40.7±4.2)h、(41.6±3.9)h和(90.6±8.4)h,均显著短于对照组【分别为(49.8±5.3)h、(50.4±21.5)h和(103.7±4.1)h,P＜0.05】。结论在LC术后应用盐酸纳布啡多模式镇痛有助于缓解疼痛,可能与其抑制了疼痛相关因子释放有关。

关键词: 胆囊息肉, 腹腔镜胆囊切除术, 双侧腹横肌平面阻滞, 静脉自控镇痛, 盐酸纳布啡, 镇痛

Abstract: Objective The aim of this study was to investigate multimodal nalbuphine hydrochloride analgesia in patients with gallbladder polyps (GP) after laparoscopic cholecystectomy(LC). Methods 78 patients with GP were encountered in our hospital between November 2020 and March 2024, and all underwent LC surgery. For post-operational analgesia, patients were randomly divided into control and observation groups, 39 cases in each. Bilateral transversus abdominis plane block (TAP) and patient-controlled intravenous analgesia (PCIA) were conducted, nalbuphine were given in observation, and flurbiprofen ester were administered in the control. Visual analogue scale (VAS) and Ramsay sedation scale (RSS) were evaluated, and serum substance P (SP) and prostaglandin E2 (PGE2) levels were assayed by RIA. Results By 1, 4 and 12 hours after surgery, VAS scores in the observation group were(3.7±0.7)points, (4.0±0.8)points and (4.3±0.9)points, all much lower than [(4.3±0.7)points, (4.6±0.9)points and (4.9±1.0)points, P＜0.05] in the control; by 1, 4, 12 and 24 hours, RSS scores were (2.4±0.5)points, (2.6±0.6)points, (2.9±0.6)points and (2.5±0.6)points, all not significantly different compared to [(2.5±0.6)points, (2.7±0.6)points, (3.0±0.7)points and (2.6±0.5)points, P>0.05]; by 1, 4 and 12 hours, serum SP levels were (0.9±0.2)μg/mL, (2.7±0.6)μg/mL and (4.3±1.0)μg/mL, all much lower than [(1.3±0.3)μg/mL, (4.4±1.1)μg/mL and (6.5±1.3)μg/mL, respectively, P＜0.05], and serum PEG2 levels were (91.9±11.5)pg/mL, (265.3±29.6)pg/mL and (168.3±18.7)pg/mL, all much lower than [(108.8±12.7)pg/mL, (304.2±32.8)pg/mL and (183.2±20.6)pg/mL, respectively, P＜0.05] in the control group; post-operationally, first exhaust time, food intake and removal of drainage tube in the observation were(40.7±4.2)h, (41.6±3.9)h and (90.6±8.4)h, all much shorter than [(49.8±5.3)h, (50.4±21.5)h and (103.7±4.1)h, respectively, P＜0.05] in the control. Conclusion Application of nalbuphine hydrochloride in multimodal analgesia after LC is beneficial to relieve pain, which might be related to inhibition of pain-related substance release.

Key words: Gallbladder polyps, Laparoscopic cholecystectomy, Bilateral transversus abdominis plane block, Patient-controlled intravenous analgesia, Nalbuphine hydrochloride, Analgesia

董文岳, 安斌, 母丹, 甘建辉. 腹腔镜胆囊切除术治疗胆囊息肉患者术后纳布啡多模式镇痛应用效果分析^*[J]. 实用肝脏病杂志, 2025, 28(3): 470-473.

Dong Wenyue, An Bin, Mu Dan, et al. Multimodal nalbuphine hydrochloride analgesia in patients with gallbladder polyps after laparoscopic cholecystectomy[J]. Journal of Practical Hepatology, 2025, 28(3): 470-473.

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腹腔镜胆囊切除术治疗胆囊息肉患者术后纳布啡多模式镇痛应用效果分析^*

Multimodal nalbuphine hydrochloride analgesia in patients with gallbladder polyps after laparoscopic cholecystectomy

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