布托啡诺在全麻后气管拔管期的应用

Use of butorphanol in tracheal extubation after general anesthesia

目的:探讨布托啡诺在全麻后气管拔管期的应用效果。方法:选择18～65岁,70kg以下,ASAⅠ～Ⅱ级的全麻病人40例。随机分为布托啡诺组(n=20)和曲马多组(n=20)。全麻术毕即进入麻醉后恢复室(PACU)等待全麻苏醒拔管。布托啡诺、曲马多组分别给予布托啡诺0.03mg/kg和曲马多1.5mg/kg静注镇痛。记录病人不同时间点的生命体征,吸痰和拔管时的躁动评分,拔管后10min的清醒评分(Ramsay)、舒适评分(BCS)、满意评分及不良反应,病人的苏醒时间、拔管时间、恢复定向力时间,并进行组间比较。所有病人达到Modified Aldrete Score9分及以上则可以离开PACU回病房。结果:布托啡诺组镇痛、镇静满意,镇痛效果与等效剂量曲马多镇痛效果相似;两组对强刺激引起的心血管反应不能完全抑制,但布托啡诺组优于曲马多组(P<0.05);两组均无明显呼吸抑制作用;两组患者的躁动评分、BCS舒适评分、满意评分相似(P>0.05);两组不良反应的情况亦相似,但布托啡诺组嗜睡率较高,达40%,同时苏醒期痛苦记忆率较低。结论:布托啡诺(最大剂量不超过2mg)可以安全、有效地用于围拔管期的镇痛和镇静,病人舒适、满意。

Objective To investigate the effect of butorphanol in tracheal extubation after general anesthesia. Methods Forty ASA Ⅰ- Ⅱ patients under general anesthesia were equally randomized to receive intravenous butorphanol at a dose of 0.03 mg/kg, or tramadol at a dose of 1.5 mg/kg （control） for analgesia. The vital signs at different time points, restlessness score during sputum suctioning and extubation, Ramsay scales at 10 min after extubation, comfort score（BCS protocols）, satisfaction score, and adverse events were documented. The data were then compared between two groups. The patients whose Modified Aldrete Score was 9 or above could be dismissed from PACU. Results The analgetic and sedative effects of butorphanol were satisfied and the analgetic effective was similar to that of tramadol. The cardiovascular responses induced by strong stimulation could not be entirely inhibited by both medications but the inhibitory effect of butorphanol was superior to that of tramadol （P 〈 0.05）. No obvious respiratory suppression was occurred in two groups. Restlessness score, BCS, satisfaction score, and adverse events were also similar. A higher rate of lethargy （40%） and a lower rate of pain memory, however, were fotmd in butorphanol group. Conclusions Butorphanol（highest dose 〈 2 mg） is safe and effective for analgesia and sedation in peri-extubation. Patients are comfortable and satisfied.