| Objective:Due to the decline of organ system function in the elderly patients,their tolerance to anesthesia and surgery is relatively low,and the stress response caused by surgical trauma is adverse to the postoperative recovery in the elderly patients,so it is of great significance to choose a reasonable analgesia strategy for the postoperative recovery of such patients.Prophylactic analgesia is to enable patients to achieve a complete,long-term,covering the whole concept of perioperative analgesia.There are many prophylactic analgesics,however,conventional anesthetics often have side effects,such as prolonged recovery period,deep sedation,affecting recovery quality and so on.Therefore,it is very important and significant to find a safe and effective drug for the prevention of analgesia for the postoperative recovery of elderly patients.Nabufine is a new opioid receptor agonist antagonist,which can bind to μ and κ related receptors,and activate κ receptor at spinal cord level,so as to play a certain analgesic effect.It has been proved that nabufine has a certain analgesic effect in children,gynecology,obstetrics and other patients,with fewer complications.However,the effect of nabufine in the elderly patients undergoing surgery is The uncertain and related mechanism of action need to be further studied.Therefore,this study is to evaluate the effect of nabufine in the elderly patients with gastric cancer undergoing radical operation for preventive analgesia,to explore its influence on the hemodynamics,sedation,analgesia and other conditions during the recovery period,and to analyze its possible mechanism of action combined with the stress index,so as to provide more information basis for the clinical application of nabufine.Methods:According to the random number table method,100 elderly patients undergoing gastric cancer surgery in our hospital from February 2018 to August 2019 were divided into four groups,i.e.the control group（group C）、nabufine low dose group（group L）、nabufine medium dose group（group M）and nabufine high dose group（group H）,25 patients in each group.The nabufine group L/M/H were given 0.1 mg · kg-1,0.15 mg · kg-1,0.2 mg · kg-1 nabufine before induction of general anesthesia,respectively and the control group was given equal volume saline at the same time.The anesthesia induction of the four groups was as follows: midazolam(0.05-0.10 mg·kg-1),sufentanil(0.3-0.5μg·kg-1),etomidate(0.1-0.2 mg·kg-1),cisatracurium(0.1-0.2mg·kg-1),Anesthesia maintenance: total intravenous anesthesia,target controlled infusion of propofol and remifentanil,the initial plasma concentrations were 4 μ g · ml-1 and 4ng · ml-1,respectively.Target controlled infusion of propofol,remifentanil,and intermittent use of cisatracurium（5mg each time,with an interval of 30min）.During the operation,the BIS of the four groups was monitored and maintained between 40-60.The mean arterial pressure（MAP）and heart rate（HR）were recorded before anesthesia induction（T0）,at immediately after extubation（T1）,at 5th minutes after extubation（T2）and at 30 th minutes after extubation（T3）;the concentrations of cortisol（COR）,epinephrine（E）and norepinephrine（NE）were recorded at T0,T1,T2 and T3;the recovery time,Ramsay and vas score were recorded at 5 minutes and 30 minutes after extubation.The adverse reactions such as respiratory depression,temperature change,shivering,nausea,and vomiting were recorded.Results:（1）there was no significant difference in age,gender,weight and ASA grade among these four groups.（2）there was also no significant difference in MAP and HR among the four groups at T0（P>0.05）.however,at T1,T2 and T3,the MAP and HR indexes of the nabufine L/M/H group were lower than those in the control group（group C）（P<0.05）and there was also no significant difference in MAP and HR among these three groups（P>0.05）.（3）there was no significant difference in the level of Cor,NE and E among the four groups before anesthesia induction（T0）（P>0.05）;however,at the time of extubation（T1）,5 minutes after extubation（T2）and 30 minutes after extubation（T3）,the levels of Cor,NE and E of the nabufine group L/M/H were lower than these in the control group（Cgroup）（P<0.05）and there was no significant difference in Cor,NE and E among these three groups（P>0.05）.（4）there was no significant difference in the recovery time among the four groups（P>0.05）;The VAS score of the nabufine group L/M/H was lower,the Ramsay sedation score of the nabufine group L/M/H was higher than that of the control group（group C）at 5min after extubation,and the VAS score of the nabufine group M was the lowest,and the Ramsay Sedation score was the highest （P<0.05）.（5）the incidence of grade 0 restlessness of the nabufine L/M/H group was higher than these in the control group（group C）（P<0.05）,and the incidence of restlessness was lower than that in the control group（group C）（P < 0.05）,and the incidence of grade 0 agitation was the highest and the lowest in the nabufine group M(（P<0.05）.（6）the total adverse reactions in the nabufine group L/M/H after extubation was lower than these in the control group（group C）（P<0.05）,and the total adverse reactions in the nabufine group M was the lowest（P<0.05）.Conclusion: the preventive analgesia with nabufine before operation can effectively stabilize the hemodynamic indexes,reduce the operative stress response,improve the postoperative sedation of patients with gastric cancer,and reduce the postoperative complications.The effect of 0.15 mg · kg-1 nabufine is the most obvious,and the complications are the least. |
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