布托啡诺用于抑制腹腔镜胆囊切除术瑞芬太尼麻醉后痛觉过敏

Effects of butorphanol on postoperative hyperalgesia induced by remifentanil anesthesia in patients undergoing laparoscopic cholecystectomy

目的:观察布托啡诺用于预防腹腔镜胆囊切除手术瑞芬太尼麻醉后痛觉过敏的效果。方法:本次临床观察采用前瞻性、随机、对照和双盲设计。选择60例行择期腹腔镜胆囊切除手术患者,采用抽签法将患者随机分为对照组(C组)和布托啡诺组(B组),每组30例。麻醉方法均为静吸复合全麻,术中采用丙泊酚、瑞芬太尼持续静脉泵注及吸入七氟烷维持麻醉。B组于术中胆囊切除手术步骤完成之后立即静脉给予布托啡诺20μg.kg-1,C组给予等体积生理盐水。分别于患者苏醒后30,60和120 min行视觉模拟疼痛(VAS)评分、Ramsay镇静评分,并记录两组患者自主呼吸恢复时间、苏醒时间、拔管时间以及术后要求镇痛患者例数、镇痛药物用量和麻醉苏醒后2 h内的不良事件。结果:C组30～120 min VAS评分高于B组(P<0.05);B组术后要求镇痛的患者例数、镇痛药物用量以及恶心、呕吐、寒战等不良事件发生率均低于C组(P<0.05);两组患者各时点Ramsay评分、自主呼吸恢复时间、苏醒时间和拔管时间无统计学显著差异。结论:布托啡诺可有效预防腹腔镜胆囊切除术瑞芬太尼麻醉后的痛觉过敏,且不增加不良反应发生率。

Objective： To evaluate the effect of butorphanol on postoperative hype remifentanil in patients undergoing laparoscopic cholecystectomy. Methods： This prospective ralgesia induced by study was performed using a randomized, controlled and double-blind design. Sixty ASA Ⅰ - Ⅱ patients scheduled for elective laparo- scopic cholecystectomy under general anesthesia were randomly divided into 2 groups by drawing lots： control and butorphanol groups. All patients received combined intravenous ＋ inhalational anesthesia, and the anesthesia was maintained with propofol, remifentanil and sevoflurane. Patients in butorphanol group received 20 μg·b^-1 butor- phanol after the cholecyst had been removed, and those in control group received the same volume of normal saline. VAS and Ramsay scores were assessed at 30, 60 and 120 min after awakeness. Postoperative recovery time of spon- taneous breath, the time of awakeness and extubation, the number of patients who need tramadol, and the dosage of tramadol, as well as the adverse reactions such as nausea, vomit and shiver, were recorded for 2 h after surgery. Results： The postoperative VAS scores were higher in control group than in butorphanol group （P 〈 0.05）. The number of patents who need tramadol and the tramadol dosage used were lower in butorphanol group than in control group （P 〈 0.05）. The adverse reactions （nausea, vomit and shiver） were also lower in butorphanol group than in control group （P 〈 0.05）. There was no significant difference between the two groups in Ramsay score and postop- erative recovery. Conclusion： Butorphanol has a significant suppressive effect on postoperative hyperalgesia in- duced by remifentanil-based anesthesia.