The Study On Nalbufine Combined With Dexmedetomidine For Patient Controlled Intravenous Analgesia After Thoracoscope Pulmonary Lobectomy

Objective:To observe the analgesic effect of nalbuphine hydrochloride injection on intravenous analgesia in patients undergoing thoracoscope pulmonary lobectomy and its effect on inflammatory response.Methods:The study subjects were 120 patients who underwent thoracoscopic lobectomy from October 2017 to December 2018 in our hospital.The ASA classification was grade I-II,ages were from 30 to 65 years old,and their BMI was less than30kg/m~2,the gender was not restricted.They were randomly divided into three groups(n=40 each):nalbuphine combined with dexmedetomidine(ND)group,nalbuphine(N)group and sufentanil(S)group.All patients underwent patient controlled intravenous analgesia(PCIA).The drugs composition of the analgesic pump in the ND group was nalbuphine 2.5 mg/kg+dexmedetomidine 4μg/kg+tropisetron 5 mg,N group was nalbuphine 2.5 mg/kg+tropisetron 5 mg and S group was sufentanil 2.5μg/kg+tropisetron 5 mg.All drugs were diluted to100ml with normal saline and the background infusion rate was 2 ml/h,the dose of patient-controlled analgesia(PCA)was 2 ml,then the locking time was 15 min.The resting and motor visual simulation(VAS)scores,sedation(Ramsay)scores at 2h,8h,16h,32h and 48h after surgery were observed.At the same time,The levels of IL-6 and IL-10 in the serum were measured on one day before surgery,the first day and the second day after surgery.At last,the number of times patients used PCA,side effects and satisfaction of patients for 36 hours after surgery were observed.Results:There were no significant differences in age,gender,weight,height and BMI among the three groups(P>0.05).At the resting time,the VAS scores in the ND group were lower than those in the N group at 8h,16h,32h,and48h after surgery,the difference was statistically significant(P<0.05).Compared with the S group,the VAS score in the ND group was lower than the score in the S group at 16h after surgery(P<0.05).Compared with S group,the VAS scores of N group were higher at 16h,32h,48h after operation,and the difference was statistically significant(P<0.05).The VAS scores when the patients were exercising of the ND group were lower than those in the N group at different time points after surgery(P<0.05),and the VAS scores of the N group were higher than those of the S group at 16h,32h and 48h after operation,and the difference was statistically significant(P<0.05).In addition,the Ramsay scores of the ND group were higher than those in the S group(P<0.05)at 8h,16h and 32h after operation.The Ramsay score of the ND group was higher than that of the N group and the S group at 48 hours after operation(P<0.05).In terms of side effects,the incidence of nausea and vomiting was lower in the ND group than that in the N group and the S group(P<0.05).The incidence of irritability was lower in the ND group than that in the N group(P<0.05).Compared with the S group,the incidence of skin itching was lower in the ND group than that in the S group(P<0.05).The patients’satisfaction of the ND group was higher than that of the N group(P<0.05).The satisfaction of the ND group was slightly higher than that of the S group,but the difference was not statistically significant(P>0.05).The level of inflammatory factors in the serum:Compared with the N group and the S group,the levels of IL-10 and IL-6 were higher in the ND group than those in the N group and the S group on the first day and the second day after surgery,the difference was statistically significant(P<0.05).Conclusions:Nabuphine combined with dexmedetomidine for thoracoscopic lobectomy not only has the characteristics of exact analgesic effect,but also has fewer side effects.It can also regulate the inflammatory response of patients.