布托啡诺术后静脉镇痛的临床观察

The Clinical Observation of Intravenous Analgesia with Butorphanol after Operation

目的:观察阿片受体激动-拮抗剂布托啡诺用于术后静脉镇痛的镇痛效果、不良反应及合适剂量。方法:30例妇产科手术患者随机等分两组(C1和C2),45例普外手术患者随机等分三组(P1,P2和P3),C1和P1组使用镇痛方法1:布托啡诺5mg、氟哌利多2mg加盐水至60mL;C2和P2组使用镇痛方法2(布托啡诺6mg,余同方法1);P3组使用方法3(200mg曲马多加至方法2),手术结束静脉给1mg布托啡诺负荷量后接持续镇痛泵(2mL/h)。观察术后2、4、8、12、16、20、24和30小时的镇痛效果(VAS评分)、镇静程度、呼吸抑制等不良反应。结果:同种手术镇痛效果比较:方法2比方法1好,方法3最好;同种镇痛方法在不同种类手术比较:妇产科手术镇痛效果比普外手术效果好,用方法3对普外大手术也能取得很好的镇痛效果,且不良反应和其他组一样轻微。结论:布托啡诺静脉术后镇痛效果满意且不良反应低,对较大手术加用曲马多效果满意且不增加不良反应的发生。

Objective： To verify the clinical efficacy of butorphanol with an intravenous analgesia delivery system. Methods： Thirty gynecological and obstetric patients were randomly divided into 2 groups （C1 and C2）, and 45 general surgery patients were randomly divided into 3 groups （P1, P2, and P3）. Analgesia method 1 （5 mg butorphanol and 2 mg droperidol were diluted to 60 mL with saline） was used in group C1 and P1, while group C2 and P2 used method 2 （only 5 nag butorphanol changed into 6 mg）, and group P3 used method 3 （adding 200 mg tramadol to method two）. When the operations were over （general anesthesia patients could open their eyes and were extubated）,all patients were given 1 mg butorphanol as a loading dose, and then connected the Baxter intravenous analgesia delivery system. We recorded the visual analogue score （VAS）, sedation grades, and side effects, including vomiting, nausing, itching, hypertension/ hypotension, and respiratory inhibiting at 2,4,8,12, 16,20, 24, and 30 h after the operation. Results： In the same category surgery （group C1 and C2; group P1, P2, and P3） analgesia method 2 was better than method 1, and analgesia method 3 was the best among those 3 groups. The same analgesia method would have different effect when being used in different category surgery, and the analgesia effects in gynecological and obstetric patients was better than in the general surgery. One patient vomited in all groups; and no itching, hypertension/hypotension, and respiratory inhibiting occurred. Conclusion： Intravenous analgesia with butorphanol has a considerably satisfying analgesia effect to moderate surgery, and as to major surgery, adding tramadol is more suitable. Both have little adverse effect.