| Background Severe pain after hepatectomy seriously restricts the recovery process of patients.Safe and effective postoperative analgesia strategy can control the pathophysiological reaction during perioperative period,reduce surgical trauma and postoperative stress,improve the quality of postoperative analgesia,and promote the rapid recovery of patients after hepatectomy.Objective To investigate the postoperative analgesic effect and rapid rehabilitation value of nalbuphine and sufentanil combined in patients with hepatectomy,guide patients undergoing hepatectomy to carry out postoperative analgesia safely and effectively,and promote patients’rapid recovery.Methods Totally 120 patients scheduled for hepatectomy from December 2019 to March2021 were randomly divided into sufentanil group(group S,n=40),nalbuphine group(group N,n=40)and combination group(group SN,n=40).After surgery,patients in group S received 2.5μg/kg sufentanil+10mg tropisetron+100ml normal saline PCIA;patients in group N received 2mg/kg nalbuphine+10mg tropisetron+100ml normal saline PCIA;group SN received 1mg/kg nalbuphine+1.25μg/kg sufentanil+10mg tropisetron+100ml normal saline PCIA.The pain VAS scores of the three groups at 6,12,24 and 48h after operation were evaluated;The total number of PCIA compressions,the use of pain relief and vomiting relief drugs within 48h after operation were compared;Enzyme-linked immunosorbent assay was used to detect serum TNF-αlevel,electrochemiluminescence method to determine serum IL-6index level,and flow cytometry to detect the proportion of CD3~+,CD4~+,CD8~+and the ratio of CD4~+/CD8~+in the peripheral blood T lymphocytes of the patient at 1d,24h and 48h after operation;Pearson correlation analysis was used to analyze the correlation between pain VAS score and inflammatory factors and immune factors;Common postoperative complications were observed in the three groups,and the first exhaust and defecation time,hospitalization days and total hospitalization expenses were recorded;The overall satisfaction of patients with postoperative analgesia was evaluated.Results(1)There was no statistical difference in the distribution of general information such as age,liver function classification,operation time,and intraoperative blood loss among the three groups(P>0.05);(2)The VAS scores at different time points after operation in group N were slightly higher than those in group S(P>0.05),and the VAS scores at each time point after operation in group SN were significantly lower than those in groups S and N(P<0.05);(3)The total number of PCIA compressions within 48 hours after operation in group N was slightly more than that of the group S(P>0.05),and the total number of compressions in group SN was significantly less than that in groups S and N,and the difference was statistically significant(P<0.05);(4)The dosage of pain relief drugs within 48 hours after operation in group S was lower than that in group N(P<0.05),but the dosage of vomiting relief drugs in group S was higher than that in group N(P<0.05),while the dosage of pain relief and vomiting relief drugs in group SN were significantly lower than those in groups S and N,the differences were statistically significant(P<0.05);(5)The serum TNF-α,IL-6levels and peripheral blood T lymphocyte subsets of the three groups of patients had no statistical significance at 1d before surgery(P>0.05),and the levels of TNF-αand IL-6 in group N were higher than those in group S at 24h and 48h after operation,but there was no statistical difference(P>0.05),while the TNF-αand IL-6 levels in group SN at 24h and 48h after surgery significantly lower than that in group S and N,the difference was statistically significant(P<0.05);Compared with the group S,the levels of CD3~+,CD4~+,CD4~+/CD8~+in group N increased at 24h after surgery,showing statistical differences(P<0.05),and the level of CD3~+,CD4~+/CD8~+also increased 48 hours after operation,with statistical difference(P<0.05);Compared with the groups S and N,patients in group SN had CD3~+,CD4~+,CD4~+/CD8~+levels increased at 24h and 48h after surgery,and the difference was statistically significant(P<0.05);(6)Pearson correlation analysis showed that the VAS scores at 24h and48h after surgery were significantly positively correlated with IL-6 at corresponding time points(P<0.01),and the VAS scores at 48h after operation were positively correlated with CD8~+T lymphocytes(P<0.05);(7)The total incidence of postoperative complications in group S(72.5%)was significantly higher than that in group N(57.5%),and the total incidence of postoperative complications in group SN(20.0%)was the lowest,with significant statistical difference(P<0.05);(8)There were no significant differences in the first postoperative anus exhaust,the first postoperative anal defecation time,the length of hospitalization and the total hospitalization expenses between group S and group N(P>0.05),but the above indicators in group SN were significantly lower than those in group S and group N,the difference was statistically significant(P<0.05);(9)The overall satisfaction of postoperative analgesia in the SN group(95.0%)was significantly better than those in group S(60.0%)and group N(77.5%),and the difference were statistically significant(P<0.05).Conclusion Nalbuphine is used for postoperative analgesia in patients with hepatectomy,and can obtain satisfactory analgesic effects.Compared with sufentanil,its analgesic intensity is slightly weaker,but the overall satisfaction of patients with postoperative analgesia is higher.When combined with sufentanil for postoperative analgesia in patients undergoing liver resection,it can reduce the dosage of the two drugs,but it can obtain better analgesic effect than the two drugs alone,which has significant rapid rehabilitation value.Therefore,the combination of nalbuphine and sufentanil is a safe and effective new method for postoperative analgesia in patients after hepatectomy,which is worthy of clinical application. |
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