布托啡诺与氟比洛芬酯联合舒芬太尼用于妇科肿瘤术后静脉镇痛的临床效果比较

Comparison of clinical effects of butorphanol and flurbiprofen axetil combined with sufentanil on patients by controlled intravenous analgesia after the surgery of gynecological tumor

背景与目的:有效的控制妇科肿瘤手术后的急性疼痛对于患者的恢复非常重要。本研究旨在比较布托啡诺(butorphanol)和氟比洛芬酯(flurbiprofen axetil,FA)联合舒芬太尼(sufentanil)2种镇痛方案应用于妇科肿瘤术后的临床效果。方法:选择40例ASAⅠ～Ⅱ级的择期妇科肿瘤手术患者,随机分为2组,布托啡诺组(B组)和氟比洛芬酯联合舒芬太尼组(FS组)均行患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA),每组20例。全麻诱导后即静脉注射负荷剂量:B组为布托啡诺1mg,FS组为氟比洛芬酯50mg。手术结束前20min开启镇痛泵,B组为布托啡诺13mg,FS组为舒芬太尼200μg和FA150mg。术后6、12、24和48h时随访记录患者的视觉模拟镇痛评分(visual analogue scale,VAS)、Ramsay镇静评分及不良反应发生情况。结果:2组患者术后各时间点的VAS评分和PCIA48h内有效按压次数经比较,差异均无统计学意义;VAS评分均<4分,所有患者Ramsay镇静评分最高不超过3分,其中B组术后12h内明显高于FS组(P<0.05),但24h后2组间再比较,则差异无统计学意义(P>0.05);FS组恶心呕吐总的发生率明显高于B组(P<0.05);但2组均未出现皮肤搔痒和呼吸抑制等不良反应。B组镇痛泵内药物的平均费用为226.46元,FS组为671.68元,2组比较差异有统计学意义(P<0.05)。结论:与FA联合洛芬酯舒芬太尼方案相比,布托啡诺方案应用于妇科肿瘤术后能产生同样的镇痛效果,不良反应更少,性价比更高。

Background and purpose： It is important to control acute pain after gynecological oncologic surgery effectively. This study was to compare the clinical effects of butorphanol and flurbiprofen axetil （FA） combined with sufentanil on patient controlled intravenous analgesia （PCIA） after surgery. Methods： Forty ASA Ⅰ - Ⅱ patients scheduled for elective gynecological oncologic surgery under general anesthesia were randomly divided into two groups of twenty each, butorphanol group （Group B） and flurbiprofen axetil （FA） combined with sufentanil group （Group FS）. After induction Group B received a loading dose of butorphanol 1 rag, and Group FS received that of FA 50 mg. Before the operation was over, Group B received intravenous infusion of butorphanol 13 mg in 100 mL saline, whereas Group FS received that of FA 150 mg combined with sufentanil 200 μg in 100 mL saline. In the postoperative period, visual analogue scale （VAS）, Ramsay sedative scores and side effects were recorded at 6, 12, 24 and 48 h. Results： There were not any significant differences in VAS and the demanding times for supplemental bolus between the two groups. All VAS were below 4. Ramsay sedative scores of Group B before 12 h were significantly higher than those in group FS （P〈0.05）, which became similar after 24 h （P〉0.05）. The incidence of nausea and vomiting in Group FS was significantly higher than that in Group B （P〈0.05）. No respiratory depression and pruritus occurred. The average cost of analgesic drugs in Group B was￥ 226.46, was significantly lower than ￥671.68 in group FS （P〈0.05）. Conclusion：When applied to intravenous postoperative analgesia for gynecological oncologic surgery, butorphanol exhibited an analgesic effect similar to FA combined with sufentanil with less side effects and lower cost.