布托非诺治疗丙泊酚注射痛的临床观察

Clinical Observation of Butorphanol in the Treatment of Propofol Injection Pain

目的:观察布托非诺治疗丙泊酚注射痛的效果。方法:选择ASAⅠ～Ⅱ级、年龄18～38岁、自愿接受无痛人流术的早孕妇女300例,随机分为0.9%氯化钠注射液组(N)组100例、2%利多卡因组(L)组100例和布托非诺组(B)组100例,均开放手背静脉,并于注射芬太尼和丙泊酚之前分别注射0.9%氯化钠注射液2 ml、2%利多卡因2 ml(40 mg)和布托非诺1 ml(1 mg),随即由专人观察注射丙泊酚时患者手背的疼痛程度及不良反应,疼痛程度采用视觉模拟(VAS)评分法,所有患者芬太尼用量均为1μg·kg^(-1),丙泊酚用量以呼之不应、睫毛反射消失且无肢体运动时所给剂量计为实际有效剂量。结果:三组患者VAS评分:N组明显高于L组和B组(P<0.01),L组也高于B组(P<0.01)。B组丙泊酚用量明显少于N组和L组(P<0.05)。结论:布托非诺既能够解除丙泊酚注射时的手背痛,又避免了利多卡因过敏和中毒的高度危险性,且减少了丙泊酚的用量,是一种较安全、理想的无痛人流术前用药。

Objective： To observe the effect of butorphanol in treating pain of propofol injection. Method：300 early pregnant women between 18 and 38 years old who were willing to accept the painless artificial abortion （ ASA Ⅰ～Ⅱ ） were randomly divided equally into three groups, 0.9% in normal saline group（ N）, 2% of lidocaine（L） and butorphanol （B）. They were injected in their dorsal hand vein and respectively given injections of 2 ml normal saline, 2% of 2 ml lidocaine and 1 ml butophanol before injections of fentanyl and propofol. Then special persons observed the patients＇ degree of pain and adverse effects after the injection of butorphanol. The degree of pain was graded with VAS and the dosage of fentanyl was 1 μg·kg^-1. The dosage of propofol should be the real and effective one which was given when there was no response when she was called and disappearace of her eyelash reflex without any body movements. Result： According to the grading with VAS, Group N was much higher than Groups L and B （P 〈0.01 ）, Group L was higher than Group B （P 〈 0.01 ） and the dosage of butorphanol in Group B was much less than that in Groups N and L （P 〈 0.05 ）. Conclusion：Butorphanol could not only release pain caused by the injection of propofol but avoid the great risk of allergy and intoxication to lidocaine and reduce the dosage of propofol to decrease the incidence of complications such as nausea and vomitting, respiratory depression, after-pains and so on, and therefore, it was a safe and ideal medicine used before painless artificial abortion.