对乙酰氨基酚联合酮咯酸氨丁三醇对腹腔镜胆囊切除术后镇痛的影响

Effect of acetaminophen combined with ketorolac tromethamine on analgesia after laparoscopic cholecystectomy

中文关键词: 对乙酰氨基酚  酮咯酸氨丁三醇  纳布啡  腹腔镜胆囊切除术  镇痛

英文关键词: Acetaminophen  Ketorolac tromethamine  Nalbuphine  Laparoscopic cholecystectomy  Analgesia

中文摘要:

      
目的：探讨对乙酰氨基酚联合酮咯酸氨丁三醇在腹腔镜胆囊切除术（LC）患者术后早期疼痛管理中的有效性及安全性。
方法：选择择期在全麻下行LC患者90例，男42例，女48例，年龄18～78岁，BMI 18～28 kg/m²，ASA Ⅰ或Ⅱ级。采用随机数字表法分为两组：对乙酰氨基酚联合酮咯酸氨丁三醇组（AK组）和纳布啡组（NA组），每组45例。麻醉诱导前15 min，AK组静脉泵注对乙酰氨基酚500 mg（稀释至50 ml）后缓慢推注酮咯酸氨丁三醇30 mg（稀释至10 ml）；NA组于相同时点静脉泵注生理盐水50 ml后缓慢推注纳布啡0.2 mg/kg（稀释至10 ml）。记录术后0.5、3、6、12、24 h的VAS疼痛评分（非劣效性界值Δ=1.0分），手术当晚睡眠质量评分，术后24 h内补救镇痛例数，术后0.5、3、6 h的Ramsay镇静评分，术后24 h内恶心呕吐等不良反应的发生情况，以及患者总体满意度。
结果：与NA组比较，术后0.5 h AK组VAS疼痛评分明显降低（P<0.05），且两组VAS疼痛评分差值的95%CI上限低于非劣效性界值（P<0.05）。AK组手术当晚睡眠质量评分、患者总体满意度明显高于NA组（P<0.05）。两组术后24 h内补救镇痛率、不同时点Ramsay镇静评分、术后24 h内恶心呕吐发生率差异无统计学意义。
结论： 对乙酰氨基酚联合酮咯酸氨丁三醇可有效改善腹腔镜胆囊切除术后早期疼痛，不增加恶心呕吐发生率，效果不劣于纳布啡，且患者术后当晚睡眠质量评分和总体满意度更高。

英文摘要:

      
Objective: To investigate the effectiveness and safety of acetaminophen combined with ketorolac tromethamine in pain management early after laparoscopic cholecystectomy (LC).
Methods: Ninety patients with LC under general anesthesia, 42 males and 48 females, aged 18-78 years, BMI 18-28 kg/m², ASA physical status Ⅰ or Ⅱ, were selected and randomly divided into two groups by random number table method: the acetaminophen combined with ketorolac tromethamine group (group AK) and the nalbuphine group (group NA), 45 patients in each group. Group AK received 500 mg (diluted to 50 ml) of acetaminophen injection and 30 mg of ketorolac tromethamine (diluted to 10 ml) injection pumped 15 minutes before induction of anesthesia, and group NA received 50 ml of NS injection and 0.2 mg/kg of nalbuphine (diluted to 10 ml) injection pumped at the same time. Postoperative pain was recorded 0.5, 3, 6, 12, and 24 hours after surgery using VAS pain scores (the non-inferiority boundary Δ = 1.0 score). The sleep quality score on the night of surgery, the number of remedial analgesia cases within 24 hours after surgery, the Ramsay sedation score 0.5, 3, and 6 hours after surgery, the occurrence of adverse reactions such as nausea and vomiting within 24 hours after surgery, and the overall satisfaction of patients were recorded.
Results: Compared with group NA, the VAS pain scores 0.5 hour after surgery was reduced in group AK (P < 0.05). The sleep quality score and overall satisfaction in group AK were significantly higher than those in group NA (P < 0.05). There were no significant differences in the rate of remedial analgesia, the score of Ramsay sedation at different time points and the incidence of nausea and vomiting within 24 hours after surgery between the two groups.
Conclusion: Acetaminophen combined with ketorolac tromethamine is not less effective than nalbuphine in relieving early postoperative pain after laparoscopic cholecystectomy without increasing the incidence of nausea and vomiting. Patients receiving acetaminophen combined with ketorolac tromethamine have higher sleep quality scores on the night of surgery and overall satisfaction.