布托啡诺不同用药方法用于老年乳腺癌根治术超前镇痛的观察

Preemptive analgesia of different butorphanol administration methods for the elderly undergoing radical mastectomy surgery

目的观察布托啡诺不同用药方法用于乳腺癌根治术超前镇痛的效果及安全性。方法选择美国麻醉师协会(ASA)分级Ⅰ～Ⅱ级、>60岁拟择期行乳腺癌根治术的患者100例,随机分为BV1组、BV2组、BM1组、BM2组和C组(对照组),切皮前10min BV1组静注布托啡诺10μg/kg、BV2组静注布托啡诺15μg/kg、BM1组肌注布托啡诺10μg/kg、BM2组肌注布托啡诺15μg/kg、C组静注2ml生理盐水。观察并记录停药后患者呼唤睁眼时间、术后4h(T1)、8h(T2)、12h(T3)和24h(T4)视觉模拟评分(VAS评分)、术后Ramsay评分、术后24h内止痛药的使用情况及恶心、呕吐、寒颤、呼吸、循环抑制等不良反应的发生情况。结果停药后呼唤睁眼时间:BV2组较BV1、BM1、BM2和C组延长(P<0.05)。术后T1～T4时点VAS评分:BV1、BV2、BM1和BM2组明显低于C组(P<0.01),BV1、BV2、BM2组低于BM1组(P<0.05);术后Ramsay评分:BV2组评分级别高于BV1、BM1、BM2和C组(P<0.05)。术后24h内止痛药应用的次数:BV1、BV2、BM1、BM2组明显低于C组(P<0.01),BV1、BV2和BM2组低于BM1组(P<0.05)和术后恶心、呕吐、寒颤等不良反应的发生率各组间无明显差异(P>0.05),各组均未见呼吸、循环抑制的发生。结论布托啡诺在手术切皮前应用可起到超前镇痛效果,静注10μg/kg或肌注15μg/kg均能达到满意的镇痛效果且不影响全麻患者的苏醒,可有效、安全地用于老年人乳腺癌根治术。

Objective To investigate the clinic effect and security of butorphanol preemptive analgesia with different administration methods in the elderly undergoing radical mastectomy surgery.Methods 100 elective radical mastectomy patients（ASAⅠ~Ⅱ） over 60 years old,were randomly divided into the group BV1,group BV2,group BM1,group BM2 and group C（control group）.10 minutes before incision,group BV1 receives butorphanol 10μg/kg iv,group BV2 receives butorphanol 15μg/kg iv,group BM1 receieves butorphanol 10μg/kg im,group BM2 receives butorphanol 15μg/kg im,group C receieves 2ml of saline iv.Record the time from stopping drugs to open eyes,VAS score at 4 hours（T1）,8 hours（T2）,12 hours（T3） and 24 hours（T4） after operation,Ramsay score after extubation,the frequency of use of analgesics within 24 hours after operation.The occurrence of adverse reactions like nausea,vomiting,chills,respiratory and circulatory depression were also recorded.Results The time from stopping drugs to open eyes： group BV2 was significantly longer than group BV1,BM1,BM2 and C（P0.05）.At time T1~T4,VAS score of group BV1,BV2,BM1,BM2 was significantly lower than group C（P0.01）,and the VAS score of group BV1,BV2,BM2 was lower than group BM1（P0.05）.The Ramsay score after extubation of group BV2 was higher than group BV1,BM1,BM2 and C（P0.05）.The frequency of use of analgesics within 24 hours after operation： group BV1,BV2,BM1 and BM2 was significantly lower than group C（P0.01）,group BV1,BV2 and BM2 was lower than group BM1（P0.05）.There was no significant differences about the occurrence of adverse reactions among all groups（P0.05）.Conclusions Butorphanol preincisional used in surgery has the effect of preemptive analgesia,the administration methods of intravenous 10μg/kg and intramuscular 15μg/kg can achieve satisfactory analgesia without affecting the wake of the patients under general anesthesia,thus can be effectively and safely used for the elderly radical mastectomy surgery.