布托啡诺联合曲马多用于腹腔镜阴式全子宫切除术后静脉镇痛的临床效果

Clinical observation of butorphanol combined with tramadol used for postoperative analgesia in patients following laparoscopic vaginal removal of the uterus

目的 观察布托啡诺联合曲马多用于腹腔镜辅助阴式全子宫切除术术后静脉镇痛的效果.方法 选择在全麻下行腹腔镜辅助阴式全子宫切除术患者90例,美国麻醉医师协会（ASA）1～2级.随机分为布托啡诺组（A组）、曲马多组（B组）和布托啡诺联合曲马多组各30例.3组患者均采用相同的麻醉诱导和麻醉维持方式,术后均采用一次性镇痛泵静脉镇痛.镇痛泵药物：A组给予布托啡诺0.08mg/ml,B组给予曲马多10mg/ml,C组给予布托啡诺0.04mg/ml＋曲马多5mg/ml.分别记录3组术后12、24及48小时疼痛评分及镇静评分,以及48小时内恶心呕吐的发生率.结果 3组患者术后疼痛评分差异无显著性（P＞0.05）;术后12、24及48小时镇静评分差异有显著性（P＜0.05）,A组过度镇静;A组术后48小时内恶心呕吐发生率为10％,且B组为36.67％,C组为20％,组间差异有显著性（P＜0.05）,B组的术后恶心呕吐发生率最高.结论 布托啡诺联合曲马多用于腹腔镜辅助下阴式全子宫切除术术后静脉镇痛,可在镇痛效果不变的前提下,分别减少两种药物的不良反应,提高患者的满意度.

Objective To investigate the effect of of butorphanol combined with Tramadol used for postoperative analgesia in patients following laparoseopic vaginal removal of the uterus. Methods 90 patients with laparoscopic vaginal removal of the uterus were performed general anesthesia. The ASA were 1 2 grades. All cases were randomized into butorphanol group （group A, n=30） and Tramadol group （group B, n=30） and butorphanol combined with Tramadol group （group C, n=30）. The butorphanol （0.08mg/ml）, Tramadol （10mg/ml） and butorphanol （0.04mg/ml）-PTramadol （5mg/ml） were injected into Group A , Group B and Group C by analgesia pump（total 100ml）. Patients were evalu ated based on the visual analogue seale （VAS） and Ramsay score （OAA/S） at three time point, including 12 hour, 24 hour and 48 hour after the operation. The post operative nausea and vomiting （PONV） were analyzed. Results There was no significant difference in visual analogue scale. The Ramsay score （OAA/S） at three time point required was sig nificantly higher in Group A than one in Group C（P〈0.05）, and the post-operative nausea and vomiting （PONV） were significant lower in Group C than one in Group B（Group B is 36.67%, Group C is 20%, P〈0.05）. Conclusion The hutorphanol combined with Tramadol used for postoperative analgesia in patients following laparoseopie vaginal removal of the uterus can reduce the incidence of untoward effect with butorphanol and Tramadol and a rise in patient satisfaction.