| Objective:To compare the anesthetic effect and adverse reactions of different doses of nalbuphine and fentanyl in hysteroscopic surgery,analyze the clinical application characteristics of nalbuphine,and explore the best dosage of nalbuphine in hysteroscopic surgery,so as to provide reference for the application of nalbuphine in hysteroscopic surgery.Methods:After the approval of the hospital ethics committee,260 patients with ASAⅠ-Ⅱ,body mass index of 20-30 kg/m2 and age of 23-45 years old were selected for hysteroscopic resection of endometrial polyps.They had no history of drug allergy or opioid addiction.They were randomly divided into four groups:control group,Group D with fentanyl 1.5 μg/kg,experimental group,Group N1 with nalbuphine 0.1 mg/kg,group N2 with nalbuphine 0.15 mg/kg and group N3 with nalbuphine 0.2 mg/kg.There were 65 cases in each group.The anesthesia method was intravenous general anesthesia without tracheal intubation.The analgesic effect,incidence of respiratory depression and adverse reactions were compared.Results:The changes of SBP,DBP,HR and SpO2 at different time points in the four groups were statistically significant(P=0.000).The changes of heart rate in group N2 were greater than those in group D(P=0.018)and group N1(P=0.035).The total dosage of propofol in group N1(210.92 ± 50.86mg)was higher than that in group D(181.23 ± 41.06mg),group N2(189.54±39.03mg)and group N3(185.08±34.01mg)(P=0.000,P=0.004,P=0.000);the postoperative recovery time of group N1(198.62±35.26 s)was longer than that of group D(148.77 ±29.29 s),N2(133.08 ± 33.54)s)and N3(146.15±34.13 s)(P=0.000).The postoperative recovery time of group N2 was shorter than that of group D and group N3(P=0.007,P=0.025).There were statistically significant differences in postoperative pain scores of the four groups(P=0.000).The number of patients with 0-2 points(comfort)in group N1 was less than that in group D(58 cases),group N2(54 cases)and group N3(55 cases),while the number of patients with 3-4 points(mild discomfort)in group N1 was more than that in group D(7 cases),group N2(11 cases)and group N3(10 cases),the difference was statistically significant(P<0.05).The postoperative pain score of 2 patients in group N1 was 5 points,and the patients had moderate pain and discomfort.There were statistically significant differences in postoperative sedation scores among the four groups(P=0.000).The number of patients with 2-point sedation score in group D(53 cases)and group N1(45 cases)was more than that in group N2(31 cases)and group N3(18 cases),and group N3 was the least;the number of patients with 3-point sedation score in group N1(20 cases),group N2(34 cases),group N3(19 cases)were more than group D(8 cases),group N2(34 cases)was more than group N1(20 cases)and group N3(19 cases).The number of patients with postoperative sedation score of 4-5 in group D(4 cases)and group N3(28 cases)was more than that of group N1(0 case)and N2 group(0 case),and group N3(28 cases)was the most,the differences were statistically significant(P<0.05).Among them,2 patients in group N3 had postoperative sedation score of 5 points,and they were sleepy and insensitive to external stimuli.The incidence of limb activity in group N1(33.80%)was higher than that in group N2 and N3(P=0.014);the incidence of respiratory depression in group D(78.46%)was higher than that in the other three groups(P=0.000);the incidence of postoperative nausea and vomiting in group N3(33.85%)was higher than that in group D(P=0.007),and the incidence of postoperative dizziness in group N3(49.23%)was higher than that in the other three groups(P=0.000).Conclusion:1.In general intravenous anesthesia for hysteroscopic surgery,0.15mg/kg nalbuphine has better anesthetic effect than 1.5μg/kg fentanyl,with low incidence of respiratory depression,short recovery time and good sedation effect.2.Compared with other dosage groups,0.15 mg/kg nalbuphine combined with propofol has better anesthetic analgesic effect and less postoperative nausea and vomiting,dizziness and drowsiness. |
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