布托啡诺用于全子宫切除术患者硬膜外镇痛

Epidural analgesia of Butorphanol in patients undergoing complete hysterectomy

目的观察布托啡诺用于全子宫切除术患者硬膜外镇痛的临床效果,并与吗啡、芬太尼比较,为临床选择提供依据。方法ASAⅠ、Ⅱ,择期行全子宫切除术患者160例,随机分为4组:A组,硬膜外腔注射布托啡诺(江苏恒瑞医药股份有限公司,批号06112932)1mg;B组,给予吗啡1.5mg;C组,给予芬太尼0.1mg;D组给予生理盐水6mL。前3组均用生理盐水稀释至6mL。硬膜外导管与上海博创镇痛泵连接,术后4、8、12、24、36及48h进行双盲镇痛、镇静评分和舒适度评级。记录不良反应发生情况。结果VAS评分,术后4h各组间差异无显著性,但术后8、12、24、36和48hA、B、C组明显低于D组(P<0.01),而A组与B、C组相比差异无显著性(P>0.05)。BCS评分,术后4及48h评分各组差异无显著性(P>0.05),而术后8、12、24和36h各时段A组评分及8和12h的B组评分明显高于D组(P<0.01),B组在24和36h及C组在8、12、24和36h显著高于D组(P<0.05),而前3组间相比差异无显著性(P>0.05)。Ramsay评分,各时段A组显著高于后3组(P<0.01),B、C、D3组相比则差异无显著性(P>0.05)。B组恶心呕吐、皮肤瘙痒明显高于其他3组(P<0.01)。结论布托啡诺改善子宫切除术患者硬膜外镇痛效果,副作用少,安全可靠,是硬膜外镇痛可供选择的辅助镇痛药物。

[Objective] To observe the clinical effects of Butorphanol compared with Morphine and Fentanil in the patients undergoing complete hysterectomy. [Methods] One hundred and sixty patients, ASA Ⅰ-Ⅱ, selected for complete hysterectomy, were randomly divived into four groups. In group A, B and C, Butorphanol 1 mg, Morphine 1.5 mg and Fentanil 0.1 mg were injected into epidural space before 30 minutes of the operation finished, re- spectively. All analgesics were drawn as 6 mL dose diluted with normal sodium. 6 mL normal sodium was adminis- trated to epidural space in group D. The visual analogue scale, Bruggrmann Comfort Scale and Ramesay were ob- served at 4, 8, 12, 24, 36, 48 h after operation. Each patients were observed for the adverse side effects, including nausea and vomiting, pruritus and respiratory depression. [Results] The four groups were not statistically signifieally different with respect to age, height, weight or operative time. VAS score in four groups at 4 h and that among group A, B ,C were not statistical difference （P 〉0.05）. However, there were Significant difference between group A, B, C and group D in VAS score at 8, 12, 24, 36, 48 h （P 〈0.01）. BCS score： no statistical difference in group A, B, Cand in all groups at 4, 8 h （P 〉0.05）; significantly different between group A, B, C and group D at 8, 12, 24, 36 h（P 〈0.05）. Ramsay score of group A was clearly significantly higher than that of group B, C, D at all times （P 〈0.01）, the difference among group B, C, D was not statistically different （P 〉0.05）. Nausea and vomiting, pruritus in group B and A, B, D were significantly different （P 〈0.05）. [Conclusions] Butorphanol provides an alternative to Morphine and Fentani for the treatment of postoperative pain in patients undergoing complete hysterectomy and has fewer side effects.