布托啡诺对妇科腹腔镜手术患者全麻拔管期心血管反应和躁动的影响

The effect of butorphanol on cardioascular response and dysphoria during the decannulation period of general anesthesia in patients with gynecologic laparoscopy

目的:探讨布托啡诺对妇科腹腔镜手术患者全麻拔管期心血管反应及躁动的影响。方法:将全麻下择期妇科腹腔镜手术患者90例随机均分为3组(B1、B2和C组)。手术结束前30 min,B1组静脉注射(静注)布托啡诺1 mg;B2组接静脉镇痛泵予布托啡诺10 mg+盐酸雷莫司琼0.3 mg+0.9%氯化钠注射液至总量100 ml,2 ml/h持续静脉泵入;C组静注0.9%氯化钠注射液1 ml。观察3组患者术前(T1)、术毕(T2)、拔管即刻(T3)、拔管后5 min(T4)的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2),并记录拔管时间、患者清醒时间、拔管时患者躁动发生的情况及不良反应。结果:B1组T3时MAP均明显低于B2组和C组T3时MAP(P<0.01),但与T1差异无统计学意义(P>0.05)。B1组T3时的MAP和HR均明显低于B2组与C组同期的值(P<0.01),但T3时HR仍高于T1时(P<0.01)。B1组与C组T3时间SpO2均低于T1时(P<0.01),但3组间SpO2差异均无统计学意义(P>0.05)。3组拔管时间差异无统计学意义(P>0.05);B1组无或轻度躁动发生率明显高于B2组和C组,中度或重度躁动明显低于B2组和C组(P<0.01)。结论:布托啡诺1 mg能有效地抑制妇科腹腔镜手术患者全麻拔管期心血管反应,降低躁动发生率和程度。

Objeaive：To investigate the effects the butorphanol on inhibiting the cardioascular response and dysphoria during the decannulation period of general anesthesia in patients with gynecologic laparoscopy. Methods： Ninety patients scheduled for gynecologic laparoscopy under general anesthesia were randomly divided into group B1, B2 and C. Group B1, B2 and C were treated with 1 mg butorphanol, Patient Controlled Analgesia pump （ total volume 100 ml, including 10 mg of butorphanol, 0. 3 mg of Ramosetron Hydrochloride and normal saline（NS） for 2 ml per hour and 1 ml of NS by intravenous injection 30 minutes before the end of operation , respectively. Mean arterial pressure （MAP）, heart rate （HR） and saturation of peripheral oxygen（ SpO2 ） of three groups were measured at 0 rain（ T1 and T2 ） before and after surgery, extuhation （ T3 ） ,5 rains （ T4 ） after extuhation. The time of extuhation and recovery, the incidence of dysphoria and adverse reactions were recorded. Results：MAP of group B1 was significantly lower than that of group B2 and C at T3 （P 〈0.01 ） ,there was no significant difference at T1 （P 〉0.05）. HR of group B1 was significantly lower than that of group B2 and C at T3 （ P 〈 0.01 ）, and it was significantly higher than that at T~ （ P 〈 0.01 ）. SpO2 of group B1 and C at T3 were significantly lower than that at T1 （P 〈 0.01 ）. The differences of SpO2 and extubation time of three groups were no significant difference（ P 〉 0.05 ）. The incidence of no or mild dysphoria of group B1 was significantly higher than that in group B2 and C ,hut its incidence of moderate to severe dysphoria was significantly lower （P 〈 0. 01 ）. Conclusions： Bulorphanol can effectively inhibit the eardioascular response and reduce the incidence and degree of dysphoria during decarmulation period of general anesthesia in patients with gynecologic laparoscopy.