文章摘要
纳布啡静脉自控镇痛对骨折患者术前疼痛和生活质量的影响
Effect of pre-administration of nabuphine hydrochloride PCIA on preoperative pain and quality of life in patients with fracture
  
DOI：10.12089/jca.2019.03.010
中文关键词: 盐酸纳布啡  术前自控镇痛  骨折
英文关键词: Nabuphine hydrochloride  Preoperative patient-controlled analgesia  Fracture
基金项目:
作者单位E-mail
徐倩倩 410011,长沙市,中南大学湘雅二医院麻醉科  
张云 410011,长沙市,中南大学湘雅二医院麻醉科  
李卉 410011,长沙市,中南大学湘雅二医院麻醉科  
毛新展 410011,长沙市,中南大学湘雅二医院麻醉科  
戴茹萍 410011,长沙市,中南大学湘雅二医院麻醉科  
张燕玲 410011,长沙市,中南大学湘雅二医院麻醉科 zhangyanling0618@aliyun.com 
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中文摘要:
      
目的 探讨骨折患者术前预先应用纳布啡静脉自控镇痛（PCIA）的效果。
方法 选择2017年8月至12月本院急性四肢闭合性骨折患者50例，男27例，女23例，年龄25～80岁，BMI 20～25 kg/m2，ASA Ⅰ—Ⅲ级。随机分为纳布啡组（N组）和帕瑞昔布钠组（C组），每组25例，N组静脉运用盐酸纳布啡PCIA方式进行术前镇痛，C组静脉滴注帕瑞昔布钠40 mg的方式进行术前镇痛。记录用药前、用药后12和24 h患者NRS评分，记录用药前、用药后24 h患者失眠严重指数量表（ISI）评分。记录用药后24 h生活恢复质量量表（QoR-15）评分。记录吗啡追加情况以及患者恶心呕吐、嗜睡、瘙痒、呼吸抑制、注射痛等不良反应情况。
结果 与用药前比较，用药后12和24 h 两组NRS评分均明显降低（P<0.05），两组不同时点NRS评分差异无统计学意义。与用药前比较，用药后24 h N组ISI评分明显降低（P<0.05），C组不同时点 ISI评分差异无统计学意义。用药后24 h N组ISI评分明显低于C组（P<0.05），QoR15量表A卷评分明显高于C组（P<0.05），（A卷+B卷）总分明显高于C组（P<0.05）。两组追加吗啡镇痛情况差异无统计学意义。N组出现恶心呕吐1例，C组出现注射痛1例。两组患者均无嗜睡、瘙痒、呼吸抑制、寒战等不良反应发生。
结论 术前应用纳布啡PCIA，缓解了术前患者紧张焦虑情绪，有利于术前准备，对骨折患者镇痛效果满意，提高了患者生活质量。
英文摘要:
      
Objective To investigate the effect of pre-administration of nalbuphine hydrochloride by patient controlled analgesia of intravenous (PCIA) on preoperative pain and quality of life in patients with fracture.
Methods Fifty patients in our hospital with closed fractures of the limbs from August to December 2017 were enrolled, including 27 males and 23 females, aged 25 - 80 years, BMI 20 - 25 kg/m2, and ASA physical status Ⅰ-Ⅲ. All patients were randomly divided into group N (nabuphine) and group C (parecoxib), 25 cases in each group. Patients in Group N received nabuphine hydrochloride by PCIA and patients in group C received intravenous drip of parecoxib 40 mg for preoperative analgesia. The NRS scores before, 12 h and 24 h after administration were recorded. The insomnia severity index (ISI) scores before and 24 h after administration were recorded. The life recovery quality scale (QoR-15) score 24 h after administration were recorded. Morphine supplementation and adverse reactions such as nausea and vomiting, lethargy, itching, respiratory depression, and injection pain were recorded.
Results Compared with before administration, the NRS scores of the two groups were significantly lower at 12 and 24 h after administration (P < 0.05). There was no significant difference in NRS scores between two groups at different time points. Compared with before administration, the ISI score was significantly lower at 24 h after administration in group N (P < 0.05), There was no significant difference in ISI score at different time points in group C. Compared with group C, the ISI score was significantly lower at 24 h after administration (P < 0.05)，the score of volume A of QoR-15 scale was significantly higher (P < 0.05), and the total score (volume A+B) was significantly higher in group N (P < 0.05). There was no significant difference in the number of morphine supplementation between the two groups. There were 1 case sufferring from nausea and vomiting in group N and 1 case sufferring from injection pain in group C. There were no adverse reactions such as lethargy, itching, respiratory depression, and chills in both groups.
Conclusion Pre-administration of nalbuphine by PCIA for fracture patients alleviates preoperative anxiety， conducive to preoperative preparation, provides satisfactory analgesic effects, and improves the quality of life.
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