布托啡诺用于泌尿系统疾病术后镇痛的有效性和安全性

Efficacy and safety of butorphanol for postoperative analgesia in urology

目的：分析布托啡诺在泌尿外科术后镇痛中应用的有效性和安全性。方法：选取2012年4月～2013年12月全麻下行泌尿外科手术且术后接受24小时布托啡诺（0．1g／L）自控静脉镇痛（PCIA）的患者1264例，男750例，女514例，记录患者性别、年龄、身高、体重、体质指数、手术方式；术后静脉镇痛期间记录用药剂量、静止和运动疼痛评分、镇静评分、心率、血压、脉搏氧饱和度、不良反应以及患者满意度。采用多元线性回归分析多个变量与用药量的关系。结果：1264例患者术后各个时点静止视觉模拟评分为（12．2±11．1）分，活动视觉模拟评分为（15．1±12．2）分，Ramsay镇静评分为2（2，2）分，心率（79±15）次／min，收缩压（126±20）mmHg，舒张压（70±12）mmHg，脉搏氧饱和度（96±3）％，术后镇痛满意度为5（4，5）。术后镇痛不良反应中，恶心呕吐的发生率最高（4．1％），其次是眩晕（2．5％）、镇静过度（2．0％）、腹胀（0．4％）和呼吸抑制（o．2％），尿潴留的发生率最低（0．1％），无术后镇痛相关死亡。泌尿系统疾病治疗中，上下尿路手术区域显著影响术后镇痛用药量，另外，患者体重、年龄也会对术后用药剂量产生影响，但是患者的性别、身高、体质指数和手术方式不是术后镇痛用药量的决定因素。结论：布托啡诺用于泌尿外科术后PCIA是安全有效的，但用药剂量要考虑手术部位、患者体重、年龄等因素的影响。

Objective： To evaluate the efficacy and safety of postoperative analgesia by butorphanol in urology. Method： Patients receiving urological surgery under general anesthesia with postoperatvie patient-controlled intra- venous analgesia （PCIA） by butorphanol （0.1 g/L） for 24 hours from April 2012 to December 2013 were included. Patient data including sex, age, height, weight, body mass index （BMI） and operation type were collected. Total analgesia consumption, pain scores at rest and during movement, sedation score, heart rate, blood pressure, oxygen saturation, adverse effects and patient satisfaction were recorded during the PCIA course. Stepwise regres- sion analyses were conducted to select factors significantly associated with analgesia consumption. Result.. A total of 1 264 patients （750 men, 514 women） were included in the analysis. Patients had VAS scores of （12.2±11.1） at rest and （15. 1±12.2） for dynamic pain, Ramsay scores of 2 （2, 2）, heart rate of （79±15） bpm, systolic blood pressure of （ 126 ± 20） mmHg, diastolic blood pressure of （70± 12） mmHg, pulse oxygen saturation of （96±3）% and patient satisfaction with postoperative analgesia of 5 （4, 5） during PCIA course. Among adverse effects of PCIA, nausea and vomiting （4.1% ） had the highest incidence, followed by dizziness （2.5 %）, excessive sedation （2.0 % ）, abdominal distension （0.4% ）, respiratory depression （0.2% ） and urinary retention （0.1% ）. In addition, there was no postoperative analgesic-related deaths during the study period. Weight, age and operation site were significantly associated with analgesia consumption. However, sex, height, BMI and surgical type were not determinative factors of cumulative PCIA requirement. Conclusion： Butorphanol PCIA is safe and effective for postoperative analgesia after urological surgery, but the dosage should consider the impact of operation site, body weight, age and other factors.