硬膜外吗啡联合布托啡诺缓解妇科肿瘤患者术后疼痛的研究

Effect of epidural butorphanol-morphine analgesia for postoperative pain relief after gynecologic tumor surgery

目的 观察硬膜外吗啡联合布托啡诺缓解妇科肿瘤患者术后疼痛的效果.方法 美国麻醉医师协会（ASA） Ⅰ－Ⅱ级择期妇科肿瘤患者60例,随机分为A、B、C 3组,每组20例.手术结束时,经硬膜外导管给3组患者分别注入药物：A组经导管注入吗啡3 mg;B组注入吗啡3 mg加布托啡诺1 mg;C组注入吗啡3 mg加布托啡诺2 mg.术后24 h,采用视觉模拟评分（VAS）对患者进行疼痛评分,舒适评分（BCS）对患者进行舒适度评分,Ramesay评分对患者进行镇静评分,并记录恶心和皮肤瘙痒的发生情况.结果 术后24 h,3组间VAS评分差异无统计学意义（P＞0.05）;BCS评分：B组与C组明显高于A组（P＜0.05）,而B组与C组间差异无统计学意义;Ramesay评分：B组与C组明显高于A组（P＜0.05）,而B组与C组间差异无统计学意义;与A组相比,B组和C组恶心和皮肤瘙痒发生率更低.结论 对于妇科肿瘤患者,硬膜外吗啡联合布托啡诺取得良好的镇痛效果且并发症更少.

Objective To evaluate the safety and potency of epidural butorphanol-morphine analgesia for postoperative pain relief after gynecologic tumor surgery. Methods Sixty cases of gynecologic tumor patients, were randomly divided into A, B, C three groups, each group of 20 patients. At the end of operation, the analgesic drugs were injected to patients via epidural catheter： group A morphine 3 mg; group B morphine 3 mg and butorphanol 1 rag; group C morphine 3 mg and butorphanol 2 rag. 24 h later, visual analogue score （VAS）, Bruggrmann comfort scale （BCS） and Ramesay score were used to evaluate the pain, comfort and sedation of the patients respectively, and !q record the occurrence of nausea and pruritus situation. Results Postoperative 24 h, there was no significant difference between the three groups of VAS score （P〉O.05）; BCS score： group B and C was significantly higher than that in group A （P〈O.05）, but no significant difference between group B and group C; Ramesay score： group B and group !E-were significantly higher than that in group A （P〈O.05）, but there was no significant difference between group B and group C; compared with group A, group B and group C had lower incidence of nausea and pruritus. Conclusion For patients with gynecological tumors, epidural morphine combined with butorphanol has less complications and good analgesic effect.