术前不同剂量布托啡诺对宫腔镜术患者术后苏醒及镇痛的影响

Effects of different doses of butorphanol on postoperative revivescence and analgesia in hysteroscopy surgery

目的比较术前预注不同剂量的布托啡诺对宫腔镜术患者术后苏醒及镇痛作用的影响。方法 80例静脉麻醉下行宫腔镜术的患者,随机分为四组(n=20):对照组A组和观察组B1、B2、B3组。所有患者用依托咪酯、丙泊酚和瑞芬太尼麻醉,B1、B2、B3组于手术前5min分别静脉注射布托啡诺10μg/kg、20μg/kg、30μg/kg(用生理盐水稀释至10ml),对照组于同一时点静注生理盐水10ml。分别记录术后苏醒时间、评估Ramsay镇静评分、视觉模拟镇痛评分(VAS),比较患者对麻醉的满意度以及记录不良反应。结果与A组比较,B3组苏醒时间明显延长(P<0.05),而B1、B2两组差异无统计学意义(P>0.05);B1、B2、B3组术后15min的Ramsay评分较A组明显升高(P<0.05),而与B1、B2组相比,B3组Ramsay评分明显升高(P<0.05);与A、B1组比较,B2、B3组在苏醒后15minVAS镇痛评分明显降低(P<0.05),而B2、B3两组间镇痛评分差异无统计学意义(P>0.05);B3组患者术后头晕、嗜睡发生率较其他三组明显升高(P<0.05);而B2组患者对麻醉的满意度评分最高(P<0.05)。结论术前静脉注射20μg/kg布托啡诺用于宫腔镜术具有良好的术后镇痛效果,镇静适度,苏醒平稳,无明显的不良反应,是较为适宜的剂量。

Objective To investigate the effects of different doses ofbutorphanol on postoperative revives- cence and analgesia in patients who accepted hysteroscopy surgery. Methods Eighty patients, who underwent selec- tive hysteroscopy surgery, were randomly allocated into four groups, group A, group BI, group B2 and group B3 with 20 cases each. Patients in group A received intravenous physiological saline of 10 ml, while group BI, group B2 and group B3 received intravenous butorphanol of 10 μg/kg, 20 μg/kg and 30 μg/kg, respectively. The total doses ofbutor- phanol for every paitient was diluted to 10 ml with physiological saline before injection. The time of postoperative re- vivescence, Ramsay score, Visual Analogue Scale （VAS） and adverse reaction were recorded, and Satisfaction Degree Rating were compared. Results Compared with group A, the revivescence time of group B3 was significantly pro- longed （P〈0.05）, but not in group BI and B2. Ramsay score of group BI, B~ and B3 at the 15 minute point after opera- tion were increased significantly than that in group A （P〈0.05）. Compared with group A and B1, VAS score decreased significantly in group B~ and B3 at the I5 minute point after revivescenee （P〈0.05）, and there were no significant dif- ference of VAS score in this time point between group B2 and B3. The incidences of postoperative dizzy and drowsi- ness in group B3 were higher than the other three groups （P〈0.05）. The Satisfaction Degree Rating of the anesthesia was the highest in group B2 （P〈0. 05）. Conclusion For hysteroscopy patient, intravenous injection ofbutorphanol at the dose of 20 μg/kg before operation could produce a favorable analgesic effect, with moderate sedation, smooth re- vivescence and no obvious adverse reaction.