2018 年第 12 期 第 13 卷

纳布啡对多发伤患者的镇痛效果及对睡眠质量的影响

Effect of nalbuphine on analgesia and quality of sleep in patients with multiple trauma

作者：王璐陈伟谢文杰黄科生周青山魏捷

英文作者：

单位：430060武汉大学人民医院重症医学科

英文单位：

关键词：多发伤；纳布啡；镇痛；睡眠质量

英文关键词：

• 摘要：

• 【摘要】目的    探讨纳布啡对多发伤患者的镇痛效果及对睡眠质量的影响。方法    选取2017年 1月至2018年3月武汉大学人民医院重症监护病房（ICU）收治的多发伤患者66例。采用随机数字表法将患者分为纳布啡组、吗啡组和对照组，各22例，分别给予纳布啡注射液5~10 mg、吗啡注射液5~10 mg静脉推注及0.9%氯化钠注射液1~2 ml静脉推注，每4小时可追加1次给药。记录3组患者机械通气率及持续时间、连续肾脏替代治疗使用率、气管切开率、气管插管意外拔管率、脓毒症发生率、病死率及ICU住院时间。观察治疗前（T0）和治疗后4 h（T1）、12 h（T2）、24 h（T3）平均动脉压（MAP）、心率、呼吸频率。记录患者T0～T4各时点疼痛视觉模拟量表（VAS）评分。应用匹兹堡睡眠质量指数量表（PSQI）评估3组患者治疗前及治疗48 h后的睡眠状况。结果    纳布啡组患者的机械通气持续时间和ICU住院时间短于吗啡组及对照组，差异均有统计学意义（均P<0.05）。纳布啡组及吗啡组患者T2、T3时的VAS评分低于对照组［T2：（2.8±1.3）、（2.9±1.6）分比(4.0±1.5)分，T3：（2.3±1.5）、（2.6±1.4）分比（4.2±1.2）分］，T2、T3时的MAP和T3时的心率低于对照组，差异均有统计学意义（均P<0.05）；吗啡组T2、T3时的呼吸频率低于对照组，纳布啡组T2、T3时的呼吸频率高于吗啡组，差异均有统计学意义（均P<0.05）。治疗48 h后纳布啡组患者的PSQI评分较治疗前明显下降，且明显低于吗啡组及对照组同时点［（6.3±1.5）分比（9.3±1.6）、（10.0±1.9）分］，差异均有统计学意义（均P<0.05）。结论    纳布啡镇痛效果好，对呼吸影响小，能缩短机械通气及ICU住院时间，并改善多发伤患者的睡眠质量。

• 【Abstract】Objective    To investigate the effect of nalbuphine on analgesia and quality of sleep in patients with multiple trauma. Methods    Sixty-six patients with multiple trauma admitted to the Intensive Care Unit（ICU）, Renmin Hospital of Wuhan University from January 2017 to March 2018 were randomly divided into nalbuphine(N) group, morphine(M) group and control(C) group, with 22 cases in each group, having intravenous injection of nalbuphine(5-10 mg), morphine(5-10 mg) and 0.9% sodium chloride (1-2 ml) respectively. Mechanical ventilation rate and duration, continuous renal replacement therapy use rate, tracheotomy rate, accidental extubation rate, incidence rate of sepsis, fatality rate and ICU stay time were recorded. Mean arterial pressure(MAP), heart rate(HR), respiration rate(RR) and Visual Analogue Scale(VAS) for pain were analyzed before treatment（T0） and 4 h（T1）, 12 h（T2）, 24 h（T3） after treatment. Pittsburgh Sleep Quality Index(PSQI) was assessed before and 48 h after treatment. Results    Mechanical ventilation time and ICU stay time in the N group were shorter than those in the M group and C group(P<0.05). VAS score at T2 and T3［T2: （2.8±1.3）,（2.9±1.6） vs （4.0±1.5）; T3:（2.3±1.5）,（2.6±1.4） vs （4.2±1.2）］, MAP at T2, T3 and HR at T3 in the N group and M group were lower than those in the C group(P<0.05). RR at T2 and T3 in the M group were lower than those in the control group; RR at T2 and T3 in the N group were higher than those in the M group(P<0.05). PSQI score 48 h after treatment significantly decreased in the N group; it was lower than that in the M group and C group［（6.3±1.5） vs （9.3±1.6）,（10.0±1.9）］(P<0.05). Conclusion    Nalbuphine has good analgesic effect and few adverse effect on respiration; it can shorten the mechanical ventilation duration and ICU hospitalization, and improve the quality of sleep in patients with multiple trauma.