预注不同剂量布托啡诺对妇科腹腔镜患者术后镇痛效果的比较

A comparison of postoperative analgesic effects with preoperative injection of the different doses of butorphanol in patients undergoing laparoscopically hysterectomy

目的比较不同剂量布托啡诺静脉预注用于腹腔镜子宫切除术（1aparoscopically hysterectom，LH）对患者术后镇痛作用的影响。方法48例行全麻下择期LH患者，年龄35岁～60岁，ASAⅠ～Ⅱ级，采用随机数字表法随机分为4组（每组12例），B，组、B：组、B，组分别于切皮前10min缓注布托啡诺0.01、0．02、0．03mg／kg（生理盐水稀释至20m1），C组为对照组，静注生理盐水20ml，分别记录4组患者术毕苏醒时间、术后视觉模拟（visual analogue scale，VAS）评分、镇静（Ramsay）评分及副作用。所有患者的全麻药用量差异无统计学意义，术后加用镇痛药的病例予以剔除。结果B，组术毕苏醒时间（18．9±0．87）S较其他3组[（6．3±0．38）、（7．0±0．37）、（5．5±0．03）s]明显延长（P〈0．05）；各实验组术后VAS评分比C组明显降低（P〈0．05），实验组间，B2组、B3组术后VAS评分比B1组明显降低（P〈0．05）；与C组相比，各实验组术后Ramsay评分明显升高（P〈0．05），与B1组、B2组比较，B3组在术后2、4、6h的Ramsay评分明显升高（P〈0．05）。B3组术后的头晕发生率（41．6％）明显高于其他3组（P〈0．05）。结论布托啡诺0．02mg／kg静脉预注具有良好的术后镇痛效果及较少副作用，是用于妇科腹腔镜手术超前镇痛的适宜剂量。

Objective To investigate and compare postoperative analgesia effects with preoperative injection of butorphanol at different doses in patients undergoing laparoscopically hysterectomy. Methods 48 patients received general anesthesia undergoing laparoscopieally hysterectomy, ASA I -II grade, were randomly divided into 4 groups（n=12）： butorphanol 0.01, 0.02, 0.03 mg/kg was given slowly over 10 rain before skin incision to patients in B1, B2 and B3 groups respectively; saline was injected into C （control） group. Pain and sedation were assessed using visual analogue seale（VAS） and Ramsay score at 2, 4, 6, 12 h and 24 h after surgery. The time to regain consciousness and the adverse reactions （nausea, vomiting, dizziness, headache, respiratory depression, etc） were also recorded. All patients received the same anesthesia induction and maintenance of anesthesia. No analgesic drugs were used Mter surgery. Results The time to regain consciousness of B3 group （18.9±0.87） was significantly longer than that of the other three groups [（6.3±0.38）, （7.0±0.37）, （5.5±0.03） s, P〈0.05]. The VAS scores of all experimental groups were lower than C group at each postoperative time point （P〈0.05）, and the VAS scores of B2 group and B3 group were lower than Bl group at each postoperative time point（P〈0.05 ）. The Ramsay scores of all experimental groups were higher than C group after surgery, and the Ramsay scores of B3 group were significantly higher than B1 group and B2 group at 2, 4, 6 h after surgery. The incidence of dizziness in B3 group（41.6%） was higher than the other three groups （P〈0.05）. Conclusion Preoperative intravenous injection of butorphanol 0.02 mg/kg provides better postoperative analgesia with fewer adverse reactions, which is a suitable dosage for gynaecologieal laparoscopy.