含酒石酸布托啡诺或地佐辛的患者自控静脉镇痛方案在腹腔镜肿瘤根治术后患者中的应用效果

Application effect of patient-controlled intravenous analgesia regimen containing butorphanol tartrate or dezocine in patients after radical resection of tumor via laparoscope

目的探讨含酒石酸布托啡诺或地佐辛的患者自控静脉镇痛(PCIA)方案在腹腔镜肿瘤根治术后患者中的应用效果。方法选择行腹腔镜肿瘤根治术的360例患者作为研究对象,根据术后PCIA方案分为地佐辛组和酒石酸布托啡诺组,各180例。地佐辛组采用地佐辛、氟比洛芬酯、舒芬太尼的PCIA方案,酒石酸布托啡诺组采用酒石酸布托啡诺、氟比洛芬酯、舒芬太尼的PCIA方案。比较两组患者术后不同时间点的心率、平均动脉压、疼痛数字评定量表(NRS)评分、布鲁格曼舒适度量表(BCS)评分及Ramsay镇静评分(RSS),并记录麻醉苏醒期不良反应发生情况。结果术后各时间点,两组患者的心率、平均动脉压差异均无统计学意义(均P>0.05),两组患者的心率、平均动脉压亦无随时间变化的趋势(均P>0.05)。两组患者的疼痛NRS评分、BCS评分、RSS均有随时间变化的趋势(均P<0.05)。术后4 h、8 h、12 h、24 h、48 h,酒石酸布托啡诺组的疼痛NRS评分均低于地佐辛组,RSS均高于地佐辛组(均P<0.05);术后4 h、8 h、12 h,地佐辛组的BCS评分高于酒石酸布托啡诺组(均P<0.05)。两组患者麻醉苏醒期均未出现明显呼吸抑制症状,酒石酸布托啡诺组患者恶心、呕吐的发生率均高于地佐辛组(均P<0.05),但两组患者瘙痒、腹胀的发生率差异均无统计学意义(均P>0.05)。结论酒石酸布托啡诺或地佐辛用于腹腔镜肿瘤根治术后PCIA均具有较好的镇痛、镇静效果,安全性较高。含酒石酸布托啡诺的PCIA方案的镇痛、镇静作用优于含地佐辛的PCIA方案,而含地佐辛的PCIA方案舒适度更高,且恶心、呕吐发生率更低。

Objective To investigate the application effect of patient-controlled intravenous analgesia(PCIA)regimen containing butorphanol tartrate or dezocine in patients after radical resection of tumor via laparoscope.Methods A total of 360 patients undergoing laparoscopic radical resection of tumor were selected as the research subjects,and they were assigned to dezocine group or butorphanol tartrate group according to PCIA regimen after operation,with 180 cases in each group.The dezocine group received PCIA regimen of dezocine,flurbiprofen axetil,and sufentanil,and the butorphanol tartrate group received PCIA regimen of butorphanol tartrate,flurbiprofen axetil,and sufentanil.The post-operative heart rate,mean artery pressure,Numerical Rating Scale(NRS)score for pain,Bruggrmann Comfort Scale(BCS)score,and Ramsay Sedation Score(RSS)at different time points were compared between the two groups,and the occurrence of adverse reactions during anesthesia recovery period was recorded.Results At various time points after operation,the heart rate,mean artery pressure exhibited no statistically significant difference between the two groups(all P>0.05),no tendency of heart rate and mean artery pressure in the two groups was revealed over time(all P>0.05).The scores of NRS for pain,BCS and RSS in the two groups had a tendency over time.At 4 hours,8 hours,12 hours,24 hours,and 48 hours after operation,the butorphanol tartrate group yielded a lower score of NRS for pain,and a higher RSS as compared with the dezocine group(all P<0.05).The BCS score in the dezocine group was higher than that in the butorphanol tartrate group 4 hours,8 hours and 12 hours after operation(all P<0.05).No significant respiratory depression symptom was occurred in patients of both groups during anesthesia recovery period.The butorphanol tartrate group implied higher incidence rates of nausea and vomiting as compared with the dezocine group(all P<0.05);however,there was no statistically significant difference in the incidence rate of pruritus and abdominal distension between the two groups(all P>0.05).Conclusion Application of butorphanol tartrate or dezocine to PCIA after radical resection of tumor via laparoscope exerts favourable analgesic and sedative effects,and it has a relatively high safety.Employing PCIA regimen containing butorphanol tartrate exhibits a superior effect of analgesia and sedation to compared with PCIA regimen containing dezocine,whereas PCIA regimen containing dezocine interprets a higher comfort level,and lower incidence rates of nausea and vomiting.