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目的 观察纳布啡对胃癌根治术老年患者麻醉应激反应和躁动的影响.方法 选取全麻下择期行开腹胃癌根治术的老年患者90例,ASA Ⅰ ～Ⅲ级,随机分成三组,每组30例.A组患者麻醉诱导前静脉注射纳布啡0.2 mg·kg-1,手术结束前10 min给予氯化钠注射液5mL;B组麻醉诱导前给予氯化钠注射液5 mL,手术结束前10 min给予纳布啡0.2 mg·kg-1;C组在麻醉诱导前和手术结束前10 min均给予氯化钠注射液.记录三组患者麻醉诱导前(T0)、拔管时(T1)、拔管后5 min (T2)各时点的平均动脉压(MAP)和心率(HR),测定各时点血糖、血浆皮质醇和肾上腺素浓度.观察三组患者苏醒时间,拔管后5 min评估Ramsay镇静评分和苏醒期躁动评级,并观察记录不良反应发生情况.结果 T0时三组MAP、HR、血糖、血浆皮质醇和肾上腺素水平均无显著差异(P＞0.05).T1、T2时,A组和B组MAP、HR低于C组(P＜0.05),血糖、血浆皮质醇及肾上腺素水平也低于C组(P＜0.05),A组和B组之间无显著差异(P＞0.05).与A组和C组比较,B组患者苏醒时间延长(P＜0.05),Ramsay镇静评分升高(P＜0.05).与C组比较,A组和B组苏醒期躁动发生率降低(P＜0.05).三组均无严重不良反应发生.结论 术前给予纳布啡可抑制全麻苏醒期应激反应,降低躁动的发生,且不延长患者苏醒时间.“,”AIM To observe the effects of nalbuphine on stress response and emergence agitation in elderly patients undergoing gastrectomy.METHODS Ninety geriatric patients with ASA Ⅰ-Ⅲ undergoing selective surgeries of gastrectomy under general anesthesia were randomly divided into three groups (group A,group B and group C),30 cases in each group.Group A received 0.2 mg·kg-1 of nalbuphine intravenously before induction of anesthesia and 5 mL of sodium chloride injection l0 min before the end of operation,while group B received 5 mL of normal sodium chloride injection intravenously before induction of anesthesia and 0.2 mg·kg-1 of nalbuphine 10 min before the end of operation.For group C,5 mL of normal saline was given before induction and 10 min before the end of operation,respectively.The MAP and HR were recorded before induction of anesthesia (T0),extubation (T1) and 5 min after extubation (T2).And blood glucose (Glu),cortisol (Cor) and norepinephrine (E) levels were tested at T0-T2 in all groups.The recovery time,Rammsay sedation scale and agitation scale were also assessed in three groups.In addition,adverse reactions were recorded.RESULTS There were no significant differences in MAP,HR and the levels of Glu,Cor and E among three groups at T0 (P ＞ 0.05).The MAP and HR in the group A and group B were lower than those in the group C at T1 and T2 (P ＜ 0.05).And the levels of Glu,Cor and E were also lower than those in the group C at T1 and T2 (P ＜ 0.05).No significant differences were found between group A and group B.Compared with group C and group A,the recovery time of group B was longer,and Ramsay sedation scale was higher.Compared with group C,the incidence rates of emergence agitation in group A and B were significantly lower (P ＜ 0.05).No serious adverse reactions occurred in all groups.CONCLUSION Injection of nalbuphine before the surgery can effectively inhibit stress response during the recovery from general anesthesia and reduce the incidence of emergence agitation without prolonging the recovery time.