酒石酸布托啡诺与芬太尼联合用于妇科患者术后静脉自控镇痛的临床研究

Clinical Study of Combined Butorphanol with Fentanyl in Patient Controlled Intravenous Analgesia for Gynecologic Surgery Patients

目的观察酒石酸布托啡诺与芬太尼合用于术后静脉自控镇痛(PCIA)的效果及最佳混合比例。方法 2010年8月-2011年1月100例妇科手术患者,随机分为5组,每组20例。均全身麻醉术后采用负荷量+持续背景剂量+PCIA方案镇痛。根据不同配方分为F组:芬太尼1 mg+生理盐水至100 mL;B组:酒石酸布托啡诺10 mg+生理盐水至100 mL;BFⅠ组:芬太尼0.6 mg+酒石酸布托啡诺3 mg+生理盐水至90 mL;BFⅡ组:芬太尼0.5 mg+酒石酸布托啡诺5 mg+生理盐水至100 mL;BFⅢ组:芬太尼0.3 mg+酒石酸布托啡诺6 mg+生理盐水至90 mL。观察术后各时点视觉模拟评分(VAS)及镇静评分,患者满意度以及不良反应情况。结果术后早期BFⅢ组和B组VAS评分大于F组;镇静评分B组大于F组;B组满意度优良率小于其余各组;恶心呕吐发生率F组高于BFⅠ组及BFⅡ组。结论酒石酸布托啡诺和芬太尼合用于PCIA,镇痛效果确切,不良反应发生率低。推荐配比:BFⅠ组和BFⅡ组。

Objective To observe the clinical effects and optimum mixture ratio of butorphanol and fentanylin patient controlled intravenous analgesia （PCIA）. Methods One hundred gynecologic surgery patients undergoinghysteromyomectomy between August 2010 and January 2011 were randomly divided into five groups with 20 patients in each.All patients underwent analgesia with combined load quantity, continuous background infusion and PCIA. Based on differentmixture ratio, the patients were divided into five groups： group F （Fentanyl 1 mg ＋ 0.9% NaCl 100 mL）, group B （Butorphanol10 mg ＋ 0.9% NaCl 100 mL）, group BFI （Butorphano l3 mg ＋ Fentanyl 0.6 mg ＋ 0.9% NaCl 90 mL）, group BFII （Butorphanol5 mg ＋ Fentanyl 0.5 mg ＋ 0.9% NaCl 100 mL）, and group BFIII （Butorphano l6 mg ＋ Fentanyl 0.3 mg ＋0.9% NaCl 90 mL）.The pain intensity （VAS）, sedative scores （Ramsay score） and side effects after surgery were observed and recorded. Results The VAS soon after operation in group BF Ⅲ and group B was significantly higher than that in group F （P〈 0.05）, andsedative efficacy of group B was superior than that of group F （P〈0.05）. Patients’ satisfaction rate in group B was lower thanthat in other groups. The rate of PONV （Postoperative Nausea and Vomiting） in group F was significantly higher than thatin other groups （P 〈 0.05）. Conclusion PCIA with butorphanol and fentanyl can provide better efficacy of analgesia andsedation with a lower incidence of nausea, vomiting and respiratory depression in postoperative patients. The mixture ratio ofbutorphanol and fentanyl in group BFI and group BFII is better for PCIA.