Abstract:

Objective　To investigate the effect of general anesthesia with nalbuphine and fentanyl for patients undergoing radical gastric cancer surgery. Methods　A total of 120 patients undergoing radical gastrectomy for gastric cancer at Baoji People's Hospital from January to December 2023 were selected for the randomized controlled trial, and were divided into an observation group and a control group by the random number table method, with 60 cases in each group. There were 37 males and 23 females in the control group; they were (61.56 ± 4.21) years old; there were 12 cases of TNM stage I, 35 cases of stage Ⅱ, and 13 cases of stage Ⅲ; there were 14 cases of grade I of American Society of Anesthesiologists (ASA), 31 cases of grade Ⅱ, and 15 cases of grade Ⅲ. There were 31 males and 29 females in the observation group; they were (60.49 ± 4.37) years old; there were 18 cases of TNM stage I, 32 cases of stage Ⅱ, and 10 cases of stage Ⅲ; there were 19 cases of grade I of ASA, 30 cases of grade Ⅱ, and 11 cases of grade Ⅲ. The control group was anesthetized with fentanyl and normal saline, and the observation group with nalbuphine and fentanyl. The stress response indicators, vital signs, pain severities at different time points, sleep quality, and adverse events were compared between the two groups.χ² test, t test, and analysis of variance were used for the statistical analysis. Results　Forty-eight hours after the operation, the levels of superoxide dismutase, aldosterone, cortisol, and renin in the observation group were lower than those in the control group [(95.71±5.30) U/ml vs. (97.95±5.52) U/ml, (86.18±5.26) ng/L vs. (88.36±5.43) ng/L, (22.41±2.35) pg/L vs. (23.38±2.49) pg/L, and (0.75±0.17) μg/L vs. (0.83±0.26) μg/L], with statistical differences (t=2.267, 2.234, 2.194, and 1.995; all P<0.05); the mean arterial pressure, heart rate, and saturation of peripheral oxygen in the observation group were higher than those in the control group [(82.67±3.34) mmHg (1 mmHg=0.133 kPa) vs. (81.43±3.25) mmHg, (82.89±3.32) beats/min vs. (81.67±3.21) beats/min, and (90.32±3.43)% vs. (89.09±3.31)%], with statistical differences (t=2.061, 2.046, and 1.999; all P<0.05); the scores of the 7 items of Pittsburgh Sleep Quality Index in the observation group were better than those in the control group, with statistical differences (t=2.534, 2.263, 2.254, 2.383, 2.401, 2.214, and 2.509; all P<0.05). The postoperative analgesic effect of the observation group was better than that of the control group (F=21.701, P_{between groups}<0.001; F=67 557.071, P_time<0.001; F=7.953, P_interaction<0.05). The incidence rate of adverse events in the observation group was lower than that in the control group [3.33% (2/60) vs. 15.00% (9/60); χ²=4.904; P<0.05]. Conclusion　General anesthesia with nalbuphine and fentanyl during radical gastric cancer surgery can not only stabilize the patients' vital signs and reduce the stress response, but also can achieve good analgesic effect and improve their sleep quality, and is safe.

Key words:

General anesthesia, Nalbuphine, Fentanyl, Compound, Laparoscopic radical gastrectomy for gastric cancer, Pain degree, Sleep

摘要：

目的　探讨纳布啡复合芬太尼全身麻醉对胃癌根治术患者的影响。方法　选取2023年1月至12月在宝鸡市人民医院进行腹腔镜胃癌根治术的120例患者进行随机对照试验。采用随机数字表法将其分为观察组和对照组，各60例。对照组男37例，女23例，年龄（61.56±4.21）岁；TNM分期：Ⅰ期12例，Ⅱ期35例，Ⅲ期13例；美国麻醉医师学会（ASA）分级：I级14例，Ⅱ级31例，Ⅲ级15例。观察组男31例，女29例，年龄（60.49±4.37）岁；TNM分期：Ⅰ期18例，Ⅱ期32例，Ⅲ期10例；ASA分级：I级19例，Ⅱ级30例，Ⅲ级11例。对照组采用芬太尼复合生理盐水进行全身麻醉，观察组采用纳布啡复合芬太尼进行全身麻醉。对比两组应激反应指标、生命体征、不同时间点疼痛程度、睡眠质量、不良反应发生情况。采取χ²检验、t检验、方差分析进行统计分析。结果　术后48 h，观察组超氧化物歧化酶、醛固酮、皮质醇、肾素水平均低于对照组［（95.71±5.30）U/ml比（97.95±5.52）U/ml、（86.18±5.26）ng/L比（88.36±5.43）ng/L、（22.41±2.35）pg/L比（23.38±2.49）pg/L、（0.75±0.17）μg/L比（0.83±0.26）μg/L］，差异均有统计学意义（t=2.267、2.234、2.194、1.995，均P<0.05）；观察组平均动脉压、心率及血氧饱和度均高于对照组［（82.67±3.34）mmHg（1 mmHg=0.133 kPa）比（81.43±3.25）mmHg、（82.89±3.32）次/min比（81.67±3.21）次/min、（90.32±3.43）%比（89.09±3.31）%］，差异均有统计学意义（t=2.061、2.046、1.999，均P<0.05）；观察组匹兹堡睡眠质量指数中7个项目评分均优于对照组，差异均有统计学意义（t=2.534、2.263、2.254、2.383、2.401、2.214、2.509，均P<0.05）。观察组术后镇痛效果优于对照组（F=21.701，P_组间<0.001；F=67 557.071，P_时间<0.001；F=7.953，P_交互<0.05）。观察组不良事件发生率低于对照组［3.33%（2/60）比15.00%（9/60），χ²=4.904，P<0.05］。结论　胃癌根治术中采用纳布啡复合芬太尼进行全身麻醉不仅能平稳患者的生命体征，减轻应激反应，还能达到良好的镇痛效果，提高患者的睡眠质量，且具有较高安全性。

关键词:

全身麻醉, 纳布啡, 芬太尼, 复合, 腹腔镜胃癌根治术, 疼痛程度, 睡眠