布托啡诺联合地塞米松用于腹腔镜下完全腹膜外疝修补术预防性镇痛的效果分析

Analysis of preventive analgesia of butorphanol in combination with dexamethasone for laparoscopic totally extraperitoneal prosthesis

目的观察布托啡诺联合地塞米松用于腹腔镜下完全腹膜外疝修补术(TEP)预防性镇痛的效果与用药时机。方法选择ASAⅠ～Ⅱ级择期行TEP患者60例,随机分为三组,每组20例。Ⅰ组切皮前15分钟静脉注射布托啡诺1mg加地塞米松10mg;Ⅱ组手术结束前15分钟静脉注射布托啡诺1mg加地塞米松10mg;III组切皮前15分钟、手术结束前15分钟都给予生理盐水5ml。观察患者术后1、2、6、12、24h的VAS评分,三组不同时间点血流动力学和呼吸参数的比较,拔管时间的比较及术后恶心、呕吐、清醒时间躁动例数等不良反应情况的发生。结果Ⅲ组患者与诱导前相比,拔管时、拔管后5分钟,平均动脉压明显升高,心率、呼吸频率加快,与Ⅰ、Ⅱ组比较拔管时、拔管后5min有显著差异(P<0.05);术后各个时间点,I组的VAS低于Ⅱ组和Ⅲ组(P<0.05);Ⅲ组恶心、呕吐及咽喉不适发生率高于Ⅰ、Ⅱ组(P<0.05);Ⅲ组追加镇痛药止吐药的次数高于Ⅰ组(P<0.05)。结论 TEP手术时,布托啡诺联合地塞米松应用能有效缓解和延长术后疼痛,减少镇痛药的使用,减少恶心、呕吐及躁动等不良反应,可有效的抑制气管插拔管时的心血管反应。

Objective To investigate the preventive analgesic effect of butorphanol combined with dexamethasone in TEP. Methods 60 patients performed TEP, ASA, Ⅰ～Ⅱ grade, were randomized into three groups with 20 cases each group. Group Ⅰ was treated with butorpbanol 1 mg ＋ dexamethasone 10 mg before skin incision. Group Ⅱ was treated with butorphanol 1 mg ＋ dexamethasone 10 mg 15rain before the end of TEP. Group Ⅲ was treated with 5 ml saline 15min before skin incision and 15min before the end of the operation p. The VAS of the patients after lh, 2h, 6h, 12h and 24b after the operation were observed. The hemodynamics and respiratory parameters different time points were compared. The extubation time revival time and nausea, vomiting and dysphoria rate after TEP were observed. Results Group Ⅲ were significantly increased the time of and 5min after the extubation, accompanied by heart rate and respiration higher, the difference of the time of and 5min after the extubation between group Ⅰ,Ⅱ and group Ⅲ was significant （P〈0.05）. The VAS of group I at all the time points after the TEP was lower than those of group H and Ⅲ （P〈0.05）. The nausea, vomiting and sore throat rate in group Ⅲ was higher （P〈0.05）. Group In need more anodyne and antemetic than group I （P〈0.05）. Conclusion Butorphanol combined with dexamethasone could be used to relieve pain and prolong the analgesic effect after the surgery, reduce anodyne, lower the nausea, vomiting and dysphoria rate. It could also suppress the cardiovascular responses induced by endotracheal extubation.