布托啡诺与曲马多治疗妇科手术腰硬联合麻醉后寒战的效果比较

Comparison of butorphanol and tramadol on shivering during gynecological surgery under combined-spinal epidural anaesthesia

目的比较布托啡诺与曲马多在治疗妇科手术腰硬联合麻醉后寒战的效果。方法择期在腰硬联合麻醉下行妇科手术,期间出现寒战的患者40例,随机分为B组(布托啡诺组)、T组(曲马多组),每组20例,分别给予布托啡诺0.015 mg/kg或曲马多1 mg/kg处理。观察患者的平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO2),比较两组治疗寒战的疗效及术中镇静情况。结果两组患者术中生命体征平稳,两组治疗寒战的整体疗效差异无统计学意义(P>0.05);T组Ram say评分≥3分患者1例(5%),B组Ram say评分≥3分患者13例(65%),两者比较差异有统计学意义(P<0.01)。两组药物起效时间:B组(1.71±0.19)m in,T组(1.25±0.26)m in,两者比较差异有统计学意义(P=0.007)。结论布托啡诺(0.015 mg/kg)与曲马多(1 mg/kg)治疗腰硬联合麻醉后的寒战效果相似;布托啡诺使患者达到满意的镇静程度好,加强术中治疗寒战的效果,增加患者术中舒适度。

Objective To compare the effects of butorphanol and tramadol on shivering under combined-spinal epidural anaesthesia.Methods In this prospective,randomized study,forty patients who shivered during gynecological surgery under combined spinal epidural anaesthesia（CSEA）and requested antishivering treatment were randomly allocated to received butorphanol 0.015 mg/kg（group B,n=20）,or tramadol 1 mg/kg（groupT,n=20）.Shivering was graded using a five-point rating scale： 0=no shivering;1=one or more of the following： piloerection,peripheral vasoconstriction,peripheral cyanosis without other cause,but without visible muscular activity;2=visible muscular activity confined to one muscle group;3=visible muscular activity in more than one muscle group;4=gross muscular activity involving the entire body.Ramsay sedation score,heart rate（HR） and mean arterial pressure（MAP）,saturation of pulse oxygen（SpO2） were recorded.Results There were no significant differences between the two groups with respect to MAP,HR,intensity of shivering after CSEA,or intensity of shivering after treatment.The number of patients whose ramsay sedation score ≥3 were different between the two groups（13 vs 1,χ2=15.330,P0.01）.Conclusion The effects of butorphanol and tramadol on shivering under combined spinal epidural anaesthesia are similar;patients have higher Sedative degree by using butorphanol,compare with tramadol.