布托啡诺联合舒芬太尼应用于妇科术后静脉自控镇痛

Effects of butorphanol combined with sufentanil used in gynecologic postoperative patient-controlled intravenous analgesia

目的观察布托啡诺联合舒芬太尼应用于妇科术后患者静脉自控镇痛(PCIA)的临床效果。方法择期在全身麻醉下行妇科开腹手术的患者150例,美国麻醉医师学会(ASA)分级Ⅰ或Ⅱ级,随机分入布托啡诺组、舒芬太尼组、布托啡诺+舒芬太尼组,每组50例;镇痛药分别为布托啡诺12mg/100mL,舒芬太尼150μg/100mL,布托啡诺8mg+舒芬太尼50μg/100mL。3组均加入氟哌啶2.5mg,PCIA设置相同。在PCIA后2h(T1)、4h(T2)、8h(T3)、12h(T4)、24h(T5)、48h(T6)时间点进行随访,应用疼痛视觉模拟评分(VAS评分)评估镇痛效果,应用Ramsay评分法评估镇静程度。结果 3组均获得良好的镇痛效果,观察期间患者均无需额外的镇痛药物。布托啡诺组在T1、T2、T3时间点的疼痛VAS评分均显著高于舒芬太尼组和布托啡诺+舒芬太尼组同时间点(P值均<0.05),布托啡诺组在术后0～<2h、2～<4h、4～<8h和8～<12h时间段的患者自控镇痛需求次数均显著多于舒芬太尼组和布托啡诺+舒芬太尼组同时间段(P值均<0.05)。舒芬太尼组的恶心呕吐发生率显著高于布托啡诺组和布托啡诺+舒芬太尼组(P值均<0.01),布托啡诺组的嗜睡发生率显著高于舒芬太尼组和布托啡诺+舒芬太尼组(P值均<0.05)。结论 3种静脉自控镇痛给药方式均获得满意的镇痛效果。布托啡诺联合舒芬太尼的镇痛效果确切,且不良反应更少。

Objective To observe clinical outcomes of butorphanol combined with sufentanil in patient- controlled intravenous analgesia （PCIA） after gynecologic surgery. Methods A total of 150 patients scheduled for selective gynecologic celiotomy under general anesthesia, American Society of Anesthesiologists （ASA） Ⅰ or Ⅱ , were randomly divided into butorphanol group （butorphanol 12 mg/100 mL）, sufentanil group （sufentanil 150 μg/100 mL） and combined group （butorphanol 8 mg and sufentanil 50 μg/100 mL）. There were 50 patients in each group. Droperidol 2.5 mg was added and the same pattern of PCIA was set in the three groups. At 2 h （T1）, 4 h （T2）, 8 h （T3）, 12 h （T4）, 24 h （T5） and 48 h （T6） after PCIA, the patients were followed up with visual analog scale （VAS） and Ramsay scores to assess analgesia and sedation. Results Good analgesic effect was achieved in all patients and none needed additional analgesic drugs in the treatment of pain. At T1, T2 and T3 time points, VAS score in butorphanol group was significantly higher than those in the other two groups （all P〈0. 05）. In each period of time, 0- 〈2 h, 2- 〈4 h, 4- 〈8 h and 8- 〈 12 h after surgery, the frequency of PCIA in butorphanol group was significantly higher than that in the other two groups （all P〈0. 05）. The incidence of nausea and vomiting in sufentanil group was significantly higher than that in the other two groups （both P〈0. 01 ）. The incidence of drowsiness in butorphanol group was significantly higher than that in the other two groups （both P〈 0.05）. Conclusion All the three therapies are able to provide satisfactory analgesia effect. The combination of butorphanol and sufentanil can achieve more precise analgesia and has less side effects as compared with the other two methods.