探讨纳布啡联合瑞芬太尼用于腹腔镜完全腹膜外腹股沟疝手术术后效果。

选择2020年1月至2022年6月诊断为腹股沟疝后收入盐城市第三人民医院接受手术治疗的患者88例作为研究对象，进行前瞻性研究。依据随机数字表法分为对照组和观察组，各44例。两组患者气管插管全身麻醉后均采用腹腔镜下完全腹膜外（TEP）腹股沟疝修补手术。观察组在手术完成前5 min输注纳布啡。对照组患者则输注等量的生理盐水。对比两组手术完成时、拔管时、术后0.5 h的平均动脉压、心率、血氧饱和度。采用视觉模拟评分（VAS）法评估并比较两组术后0.5、2、6、12 h的镇痛效果。比较两组因麻醉药物诱发的不良反应。对比两组术前0.5 h、术后4 h的血清应激反应指标[肾上腺素、去甲肾上腺素（NE）、皮质醇]、血清炎性反应指标[白细胞介素-6（IL-6）、C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）]。

两组患者在手术完成时、拔管时、术后0.5 h的平均动脉压、心率、血氧饱和度差异无统计学意义（P>0.05）。观察组在术后2、6、12 h VAS评分均低于对照组（P<0.05），两组患者术后0.5 h VAS评分差异无统计学意义（P>0.05）。两组患者术后均未出现麻醉药物诱发的不良反应。两组患者术前0.5 h肾上腺素、NE、皮质醇、IL-6、CRP、TNF-α比较差异均无统计学意义（P>0.05），在术后4 h均增高，且观察组均低于对照组（P<0.05）。

气管插管全身麻醉下行TEP手术的腹股沟疝患者，利用纳布啡可降低术后疼痛程度，降低应激反应及炎性反应程度，且不增加药物不良反应风险。

To explore the effect of nalbuphine combined with remifentanil after laparoscopic totally extra-peritoneal inguinal hernia repair (TEP) surgery.

A prospective study was conducted on 88 patients with inguinal hernia who were admitted to Yancheng Third People's Hospital for surgical treatment from January 2020 to June 2022. All patients were divided into control group (n=44) and observation group (n=44) according to random number table method. All patients in the two groups underwent TEP after tracheal intubation general anesthesia. The observation group was given nalbuphine 5 minutes before the end of operation. The control group was given the same amount of normal saline. The mean arterial pressure, heart rate and blood oxygen saturation at the time of operation completion, extubation and 0.5h after operation were compared between the two groups. The analgesic effects of the two groups at 0.5, 2, 6, and 12 h after operation were compared using visual analog score (VAS). The adverse reactions induced by anesthetic drugs in the two groups were compared. The serum stress response indexes [adrenaline, noradrenaline (NE), cortisol], serum inflammatory response indexes [interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α)] of the two groups were compared 0.5 h before and 4 h after surgery.

There was no significant difference in mean arterial pressure, heart rate and blood oxygen saturation between the two groups at the time of operation completion, extubation and 0.5h after operation (P>0.05). The VAS scores in the observation group at 2, 6, and 12 h after operation were lower than those in the control group (P<0.05). There was no significant difference between the two groups in VAS score 0.5 h after operation (P>0.05). There was no adverse reaction induced by anesthetic drugs in both groups. There was no significant difference in adrenaline, NE, cortisol, IL-6, CRP, TNF-α between the two groups at 0.5 h before operation (P>0.05). Adrenaline, NE, cortisol, IL-6, CRP, TNF-α increased in both groups at 4 h after operation, and those in the observation group were lower than those in the control group (P<0.05).

In inguinal hernia patients with TEP surgery under tracheal intubation general anesthesia , the use of nalbuphine can reduce the degree of postoperative pain, stress reaction and inflammatory reaction intensity, without increasing the risk of adverse drug reactions.