酒石酸布托啡诺用于日间宫腔镜检查的镇痛效果观察

Analgesic effect of butorphanol in office operative hysteroscopy

目的探讨酒石酸布托啡诺用于门诊宫腔镜检查术的镇痛效果。方法纳入我中心2018-2019年110例需接受宫腔镜检查术的患者,随机分为2组:酒石酸布托啡诺组(N组)55例,静滴酒石酸布托啡诺0.02 mg/kg,5~10 min后静注丙泊酚1~2 mg/kg;芬太尼+咪达唑仑组(F组)55例,静滴芬太尼2μg/kg和咪唑0.02 mg/kg,5~10 min后静注丙泊酚1~2 mg/kg。记录两组在分别给予酒石酸布托啡诺或芬太尼后3 min、5 min、10 min的血压、丙泊酚负荷量、丙泊酚总量、手术持续时间,以及扩宫体动、呼吸抑制、术后唤醒时间、苏醒评分,术后30 min内有无宫缩痛以及各种不良反应。结果N组脱落2例,F组脱落4例,两组一般资料及手术时间无统计学差异(P>0.05)。N组与F组在唤醒时间[(2.45±0.85)min vs(2.16±0.83)min]、扩宫时体动(1.8%vs 3.9%)等方面差异无统计学意义(P>0.05)。两组药物起效后血压均有不同程度下降,对照组更低(P<0.05)。术后宫缩痛评分N组明显低于F组(0.17±0.64 vs 0.71±1.15,P=0.004),F组苏醒评分优于N组(4.90±0.46 vs 4.58±0.50,P=0.001),F组在丙泊酚用量上也明显低于N组[(213.73±47.11)mg vs(258.40±33.73)mg,P<0.001]。结论酒石酸布托啡诺用于日间宫腔镜手术与传统的镇静镇痛药相比,唤醒时间及扩宫体动指标无明显差异,但可明显降低术后宫缩痛,传统镇静镇痛在丙泊酚用量及苏醒评分上更有优势。

Objective To investigate the analgesic effect of butorphanol in outpatient hysteroscopy.Methods From 2018 to 2019,110 outpatients who underwent hysteroscopy in our center were randomly divided into two groups:55 cases in butorphanol group(group N)and 55 cases in fentanyl+midazolam group(group F).Patients in the group N were injected with Butorphanol(0.02 mg/kg),and those in the group F with fentanyl 2μg/kg and imidazole(0.02 mg/kg).After 5-10 min,patients in each group were given propofol(1-2 mg/kg).Blood pressure was recorded at 3 min,5 min and 10 min after administration of butorphanol or fentanyl,respectively.Meanwhile,the loading dose of propofol,the total dosage of propofol,the duration of operation,the cervical response,respiratory depression,wake-up time after operation,wake-up score,uterine contraction pain within 30min after operation and adverse reactions were recorded.Results Two cases in group N and 4 cases in group F were dropped out.There was no significant difference in wake-up time([2.45±0.85]min vs[2.16±0.83]min)and cervical response(1.8%vs 3.9%)between the group N and the group F(P>0.05);while the blood pressure in both groups decreased after the drug took effect,and it was significantly lower in the group N compared to the group F(P<0.05).The postoperative uterine contraction pain in the group N was significantly lower than that in the group F(0.17±0.64 vs 0.71±1.15,P=0.004),while the wake-up score in group F was superior to that in group N(4.90±0.46 vs4.58±0.50,P=0.001),and the propofol dosage in group F was also significantly less than that in group N([213.73±47.11]mg vs[258.40±33.73]mg,P<0.001).Conclusion For patients undergoing hysteroscopic surgery,butorphanol provide better effect on postoperative uterine contraction pain management,similar wake-up time and cervical response.