布托啡诺复合舒芬太尼用于功能性鼻内窥镜术后静脉自控镇痛

Application of butorphanol combined sufentanil in self controlled intravenous analgesia after functional endoscopic sinus surgery

目的:探讨布托啡诺复合舒芬太尼用于功能性鼻内窥镜术后静脉自控镇痛的可行性和安全性。方法:40例择期功能性鼻内窥镜手术的患者,年龄18～65岁,ASAⅠ～Ⅱ级,随机分为两组。每组20例,两组术毕前30min静脉缓注布托啡诺0.75mg。Ⅰ组:布托啡诺4mg+舒芬太尼100μg+昂丹司琼8mg;Ⅱ组:舒芬太尼150μg+昂丹司琼8mg,每组均用0.9%生理盐水稀释到200ml,背景剂量3mL/h,PCA2mL,锁定时间15min。分别记录术后4、12、24和48h的平均动脉压、心率、呼吸频率、脉搏、氧饱和度(SpO2)、患者平静时的视觉模拟(VAS)疼痛评分及Ramsay评分法评估镇静程度,统计不良反应并在镇痛结束后统计患者对镇痛治疗的总体满意度。结果:两组患者术后各时间点平均动脉压(MAP)、HR及SpO2和术后各时段VAS评分及Ramsay评分差异无统计学意义(P>0.05),显示两组均获得满意的镇痛效果;两组患者术后呼吸抑制、嗜睡、恶心、呕吐、皮肤瘙痒等不良反应的发生率差异无统计学意义,患者满意度差异亦无统计学意义。结论:布托啡诺复合舒芬太尼用于功能性鼻内窥镜术后静脉自控镇痛,能够达到满意的效果,是一种安全有效的术后镇痛的方法。

Objective：To explore the feasibility and safety of self controlled intravenous analgesia of butorphanol combined sufen-tanil after functional endoscopic sinus surgery. Methods：40 cases of elective functional endoscopic sinus surgery,aged 18～65 years old,ASAⅠ～Ⅱ grade,were randomly divided into two groups,20 patients in each group.The two groups were given the slow intravenous injection butorphanol 0.75 mg at 30 min before operation complete. Group Ⅰwas given butorphanol 4 mg＋sufentanil 100 μg＋ondansetron 8 mg;group Ⅱ was given sufentanil 150 μg＋ondansetron 8 mg. In each group,0.9% saline was diluted to 200 mL,with the background dose of 3 mL/h,PCA 2 mL,lockout time 15 min. At 4,12,24 and 48 h after operation recording the mean arterial pressure,heart rate,respiratory rate,pulse saturation,visual analogue scale （VAS） of pain score in calm. The Ramsay sedation scoring assessment was used to eraluate the sedation level.The adverse reactions and the overall patient satisfaction were statistically analysed.Results：In the two groups of patients at different time points,MAP,HR,SpO2,post-operative VAS score of all time and Ramsay score had no statistically significant difference（P〉0.05）,showing the satisfactory analgesic effect in both groups.The incidence rate suchas postoperative respiratory depression,drowsiness,nausea,vomiting and skin itching had no significant difference between the two groups.The satisfaction had no significant dif-ference. Conclusion：Self controlled intravenous analgesia of butorphanol combined sufentanil after functional endoscopic sinus surgery can achieve satisfactory effect,which is a safe and effective method of postoperative analgesia.