地佐辛复合布托啡诺对老年患者术后镇痛的临床研究

Clinical research of dezocine combined butorphanol for postoperative analgesia in elderly patients

目的 观察地佐辛复合布托啡诺应用于老年患者术后镇痛的效果.方法 气管插管全麻行经腹胃癌根治术和经胸食道癌或贲门癌根治术老年患者共40例,随机数字表法分为地佐辛复合布托啡诺组（Ⅰ组）和布托啡诺组（Ⅱ组）,每组20例.术前苯巴比妥钠0.1g、阿托品0.5 mg肌注.常规静脉诱导气管插管后行机械通气.丙泊酚、瑞芬太尼及顺式阿曲库胺维持麻醉.手术结束前30 min,给予镇痛负荷剂量、开启镇痛泵.Ⅰ组配方为地佐辛25 mg和布托啡诺8 mg加格拉斯琼3 mg,Ⅱ组配方为布托啡诺13 mg加格拉斯琼3 mg,均以生理盐水稀释至150 ml.3 ml/h持续静脉泵入,Bolus剂量3ml/次,锁时15 min,最大剂量9 ml/h.记录苏醒时间、拔管时间.VAS评分法评估镇痛、恶性呕吐程度;Ramsay评分法评估镇静程度;M MSE量表评估认知功能.结果 术后48 h,地佐辛复合布托啡诺组镇痛评分[（1.75±0.44）分]低于布托啡诺组[（2.25±0.79）分（P＜0.05）].术后6h,布托啡诺组镇静评分[（3.75±0.79）分]高于地佐辛复合布托啡诺组[（2.15±0.75）分（P＜0.05）].术后48 h,地佐辛复合布托啡诺组（0分）恶心呕吐评分低于布托啡诺组[（0.70±1.30）分（P＜0.05）].与术前1天相比,两组患者术后6 h MMSE评分均降低,且布托啡诺组MMSE评分[（15.00±2.00）分]低于地佐辛复合布托啡诺组[（20.95±1.54）分（P＜0.05）].结论 地佐辛复合布托啡诺静脉术后镇痛可安全应用于老年患者,且副作用少于单纯布托啡诺镇痛组.

Objective To observe the effect of combined dezocine with butorphanol for postoperative analgesia in elderly patients.Methods Totally 40 patients older than 65 years under general anesthesia for abdominal radical resection of gastric cancer or thoracic esophageal cancer or cardia carcinoma radical resection were randomly divided into combined dezocine with butorphanol group （group Ⅰ） and butorphanol group （group Ⅱ）,20 cases of each group.Before operation,phenobarbita 0.1 g and atropine 0.5 mg im.The operations were under total intravenous anesthesia with endotracheal intubation and mechanical ventilation.Propofol,remifentanil and cisatracurium maintain anesthesia.Thirty minutes before the end of operation,analgesic load dose was given and opened the analgesia pump.Group Ⅰ：dezocine 25 mg,butorphanol 8 mg and granisetron hydrochloride 3 mg.group Ⅱ：butorphanol 13 mg and granisetron hydrochloride 3 mg.The volume was diluted with saline to 150 ml.Continuous intravenous infusion velocity was 3 ml/h.Bolus dose was 3 ml/time,lock time was 15 min and maximum dose was 9 ml/h.The time of recovery and extubation were recorded.VAS score was used to assess pain,nausea and vomiting ; Ramsay score was used to evaluate the degree of sedation; Cognitive functions were evaluated with MMSE scale.Results 48 h postoperatively,VAS score of group Ⅰ （1.75±0.44） was lower than that of group Ⅱ （2.25±0.79） （P〈0.05）.6 h postoperatively,sedation score of group Ⅱ （3.75±0.79）was higher than that of group Ⅰ（2.15±0.75） （P〈0.05）.48 h postoperatively,nausea and vomiting scores of group Ⅰ （0） was lower than that of group Ⅱ （0.70 ± 1.30） （P〈0.05）.Compared with the MMSE score at 1 d postoperatively,the MMSE scores of two groups decreased at 6 h postoperatively,and the MMSE score of group Ⅱ （15.00±2.00） was lower than that of group Ⅰ（20.95±1.54） （P〈0.05）.Conclusion Intravenous dezocine combined butorphanol for postoperative analgesia in elderly patients is safe,and the side effects are less than that of the pure butorphanol analgesia.