布托啡诺与布托啡诺加高乌甲素用于妇科手术后PCIA的效果

The evaluation of butorphanol and lappaconite versus butorphanol alone for PCIA post gynecological surgery

目的评价布托啡诺与布托啡诺加高乌甲素用于妇科手术后静脉自控镇痛(PCIA)的效果与不良反应。方法将40例妇科手术患者随机分成A、B2组,每组20例,2组PCIA镇痛药液A组选用布托啡诺8mg,B组选用布托啡诺5mg加高乌甲素32mg进行镇痛,在镇痛开始时2组均静脉注射布托啡诺1mg作为负荷量,静脉注射盐酸托烷司琼2mg预防术后恶心、呕吐。观察术后1、6、12、24、36、48h生命体征监测指标和不良反应的发生情况,并进行双盲镇痛、舒适度和镇静评分。结果 (1)视觉模拟评分法(VAS)评分:手术后12h,A组与B组VAS比较差异有统计学意义(P<0.05)。(2)VAS总体分布:镇痛良好A组占80%,B组占55%;镇痛基本满意:A组占20%,B组占45%。2组比较差异无统计学意义(P>0.05)。(3)BCS评分:手术后不同时间点2组BCS比较,差异均无统计学意义(P均>0.05)。(4)Ramesy评分:手术后不同时间点2组Ramesy评分比较,差异均无统计学意义(P均>0.05)。(5)不良反应的发生情况:2组不良反应发生率的比较,差异无统计学意义(P>0.05)。(6)2组镇痛药的价格,B组>A组。结论妇科手术后PCIA,选择布托啡诺8mg较布托啡诺5mg加高乌甲素32mg,在镇痛效果、不良反应发生的发生率和效价比等方面,更具有临床优势,但尚需进一步的大样本研究证实。

Objective To evaluate the effect and adverse reactions of butorphanol plus lappaconite versus butorphanol alone in patients using patient-controlled intravenous analgesia （PCIA） after gynecological surgery. Methods Forty patients using PCIA after gynecological surgery were randomly divided into A and B groups （n = 20 each）. The PCIA analgesic liquid of group A selected 8 mg butorphanol, and analgesic liquid of group B selected 5 nag butorphanol plus 32 mg lappaconite. In the beginning of the analgesia, 1 rag butorphanol was intravenously injected as a loading dose and 2 nag hydrochloric acid tropi- setron joan was intravenously injected for the prevention of postoperative nausea and vomiting in two groups. The indexes of vital signs and adverse reactions were observed 1,6,12,24,36,48 hours after the surgery, and the scores of double-blind analgesia, comfort and sedation were performed. Results （ 1 ） visual analogue scale （VAS） ： the significant difference of VAS score was found at 12 th hour after surgery between group A and group B （P 〈0. 05） ; and the VAS scores of remaining time points were similar; （2） VAS overall distribution： satisfactory analgesia accounted for 80% in group A and 55% in group B, respectively; basically satisfactory analgesia accounted for 20% in group A and 45% in group B, respectively; there was no significant difference in VAS overall scores between the two groups （P 〉0.05）. （3） Bruggrmann comfort scale （BCS） ： no significant difference of BCS scores were found at different time points in the two groups （all P 〉 0.05 ） ; （4） Ramesy scores： no significant difference of Ranaesy scores were found at different time points in the two groups （all P 〉 0.05 ） ; （5） adverse reactions ： the incidences of adverse reactions in the two groups had no statistical significance （P 〉 0. 05） ; （6） price of analgesic drugs ： the price of group B was more than that of group A. Conclusions Compared with 5 mg butorphanol plus 32 nag lappaconite, 8 mg butorphanol for PCIA after gynecological surgery has more clinical advantages in improving the quality of an- algesia, decreasing incidence of adverse reactions and raising effect-cost ratio, but the researches of further large sample-size are warranted to prove this resuh.