纳洛酮联合瑞芬太尼注射剂用于宫颈癌根治术老年患者的临床研究

Clinical study of naloxone combined with remifentanil injection in elderly patients undergoing radical hysterectomy for cervical cancer

摘要

目的 探究纳洛酮联合瑞芬太尼注射剂在宫颈癌根治术老年患者中的临床应用效果, 评估其对术后疼痛控制、苏醒质量以及药物不良反应的影响。方法 选取2023年1月—2024年12月湖北省黄石市妇幼保健院行宫颈癌根治术的102例老年患者作为研究对象, 采用随机数字表法分为试验组和对照组, 各51例。对照组术中常规使用瑞芬太尼注射剂进行麻醉维持, 试验组在瑞芬太尼的基础上联合使用小剂量纳洛酮维持麻醉。所有患者术后接受相同的镇痛方案, 采用视觉模拟评分 (VAS) 评估术后疼痛程度, 记录患者的苏醒时间、拨管时间、术后不良反应及血清指标, 包括去甲肾上腺素 (NE)、肾上腺素 (Epi)、皮质醇 (Cor)、单核细胞趋化蛋白-1 (MCP-1) 及谷胱甘肽过氧化物酶 (GSH-Px)。结果 试验组的苏醒时间、拔管时间均短于对照组 (P<0.05)。术后, 试验组的VAS评分低于对照组 (P<0.05), 血清MCP-1、GSH-Px、NE、Epi和Cor的水平均低于对照组 (P<0.05)。试验组躁动不安、恶心呕吐、心动过缓发生率均低于对照组 (P<0.05); 两组血压升高、呼吸抑制以及尿潴留发生率比较, 差异均无统计学意义 (P>0.05)。结论 纳洛酮联合瑞芬太尼注射剂能够有效改善宫颈癌根治术老年患者的术后疼痛, 缩短苏醒时间, 具有较好的安全性。

Abstract

Objective To investigate the clinical effect of naloxone combined with remifentanil injection in elderly patients undergoing radical hysterectomy for cervical cancer, and to evaluate its effect on postoperative pain control, recovery quality and adverse drug reactions. Methods A total of 102 elderly patients who underwent radical hysterectomy for cervical cancer at Huangshi Maternity and Child Health Hospital of Hubei Province from January 2023 to December 2024 were enrolled, they were randomly divided into a trial group and a control group using a random number table, with 51 patients in each group. The control group received conventional remifentanil injection for anesthesia maintenance during surgery, while the trial group received small-dose naloxone combined with remifentanil. All patients received the same postoperative analgesia regimen, and postoperative pain was assessed using the visual analog scale (VAS). Recovery time, extubation time, adverse drug reactions, and serum indicators, including norepinephrine (NE), epinephrine (Epi), cortisol (Cor), monocyte chemoattractant protein-1 (MCP-1), and glutathione peroxidase (GSH-Px) levels were recorded for comparison. Results The trial group had shorter recovery time and extubation time compared to the control group (P<0.05). Postoperatively, the VAS scores of the trial group were lower than those of the control group (P<0.05). The serum levels of MCP-1, GSH-Px, NE, Epi, and Cor were also lower in the trial group than in the control group (P<0.05). The incidences of agitation, nausea/vomiting, and bradycardia of the trial group were lower than those of the control group (P<0.05). No significant differences were found in the incidences of hypertension, respiratory depression, or urinary retention between the two groups (P>0.05). Conclusion Naloxone combined with remifentanil injection effectively alleviates postoperative pain, shortens recovery time, and demonstrates good safety in elderly patients undergoing radical hysterectomy for cervical cancer.

关键词

纳洛酮 / 瑞芬太尼 / 宫颈癌根治术 / 术后疼痛 / 苏醒质量

Key words

Naloxone / Remifentanil / Radical hysterectomy for cervical cancer / Postoperative Pain / Recovery quality

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基金资助

^*湖北省自然科学基金计划项目(2023AFB115)