2025 年第 3 期 第 20 卷

纳布啡复合布比卡因骶管阻滞在小儿日间腹腔镜手术中的临床应用

Clinical application of nalbuphine combined with bupivacaine for caudal block in pediatric daytime laparoscopic surgery

作者：李鑫1齐林1邓红1齐灿2石磊1

英文作者：Li Xin1 Qi Lin1 Deng Hong1 Qi Can2 Shi Lei1

单位：1河北省儿童医院麻醉科，石家庄050000；2河北省儿童医院泌尿外科，石家庄050000

英文单位：1Department of Anesthesiology Hebei Children′s Hospital Shijiazhuang 050000 China; 2Department of Urology Hebei Children′s Hospital Shijiazhuang 050000 China

关键词：腹腔镜手术；纳布啡；布比卡因；骶管阻滞；血流动力学

英文关键词：Laparoscopicsurgery;Nalbuphine;Bupivacaine;Caudalblock;Hemodynamics

• 摘要：

• 目的 探讨纳布啡复合布比卡因骶管阻滞对小儿日间腹腔镜手术的麻醉效果及对机体血流动力学指标的影响。方法 选择2023年6月至2024年2月河北省儿童医院接收的120例小儿日间腹腔镜手术患者，根据随机数字表法分为复合组和对照组，各60例。对照组采用布比卡因骶管阻滞，复合组在对照组基础上加用纳布啡。比较2组镇静情况、疼痛反应指标、血流动力学指标、骶管阻滞效果及不良反应发生情况。结果 术后4、8 h，复合组Ramsay评分量表评分、视觉模拟量表评分均明显低于对照组（均P＜0.05）。复合组注射药物5 min后、切皮时心率和平均动脉压均高于对照组（均P＜0.05）。复合组感觉、运动阻滞起效时间均短于对照组［（57±6）s比（79±8）s、（145±16）s比（181±21）s］，感觉、运动阻滞持续时间均长于对照组［（177±20）min比（137±16）min、（106±13）min比（78±9）min］（均P＜0.05）。2组不良反应发生率比较差异无统计学意义（P=0.378）。结论 小儿日间腹腔镜手术采用纳布啡复合布比卡因骶管阻滞，临床应用效果较好，可有效维持机体血流动力学水平，改善镇静、镇痛效果，延长药效时间，且安全性较高。

• Objective  To investigate the anesthetic effect of nalbuphine combined with bupivacaine for caudal block on pediatric daytime laparoscopic surgery and its effect on hemodynamics. Methods A total of 120 children undergoing daytime laparoscopic surgery in Hebei Children′s Hospital from June 2023 to February 2024 were selected. According to the random number table method, they were divided into the composite group and the control group, with 60 cases in each group. The control group was given bupivacaine caudal block, and the composite group was given nalbuphine on the basis of the control group. The sedation, pain response index, hemodynamic index, sacral block effect and adverse reactions were compared between the two groups. Results At 4 and 8 h after operation, the Ramsay score and visual analogue scale score of the composite group were significantly lower than those of the control group (both P＜0.05). The levels of heart rate and mean arterial pressure at 5 min after injection and skin incision in the composite group were higher than those in the control group (all P＜0.05). The onset times of sensory and motor block in the composite group were shorter than that in the control group ［(57±6)s vs (79±8)s, (145±16)s vs (181±21)s］, and the durations of sensory and motor block were longer than that of the control group ［(177±20)min vs (137±16)min, (106±13)min vs (78±9)min］ (all P＜0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P=0.378). Conclusion Nalbuphine combined with bupivacaine for caudal block in pediatric daytime laparoscopic surgery has good clinical application effect, which can effectively maintain the body′s hemodynamic level, improve the sedative and analgesic effects, prolong the drug effect time, and has high safety.