左旋布比卡因联合布托啡诺或芬太尼用于下腹部手术硬膜外麻醉的比较

Comparison of levobupivacaine combined with butorphanol or fentanyl for epidural anesthesia in lower abdominal surgery

目的研究左旋布比卡因联合小剂量布托啡诺或芬太尼用于下腹部手术硬膜外麻醉的效果。方法选取2017年1—8月该院行腹部手术患者75例,并随机分为B组(左旋布比卡因)、BB组(左旋布比卡因+布托啡诺)和BF组(左旋布比卡因+芬太尼),各25例。观察并记录各组镇痛起效时间、镇痛完成时间、镇痛持续时间、镇痛效果评估,以及不良反应发生情况及术后视觉模拟评分量表(VAS)评分。结果 BB、BF组镇痛起效时间、镇痛完成时间、镇痛效果明显优于B组,差异均有统计学意义(P<0.05);而BB组上述指标与BF组比较,差异均无统计学意义(P>0.05)。BB、BF组VAS评分明显低于B组,差异均有统计学意义(P<0.05);而BB组术后1～3 h时VAS评分明显低于BF组,差异有统计学意义(P<0.05)。与B组比较,BB、BF组镇痛持续时间明显延长,差异均有统计学意义(P<0.05)。3组均未发生严重的心血管及呼吸方面的不良反应。结论布托啡诺及芬太尼作为硬膜外阻滞的辅助用药具有同样的安全性,可保证稳定的血流动力学,可加快麻醉的镇痛起效时间、镇痛完成时间,其中布托啡诺可显著延长术后镇痛作用。

Objective To investigate the effect of levobupivacaine combined with small dose of butorphanol or fentanyl for epidural anesthesia in lower abdominal surgery.Methods A total of 75 patients undergoing abdominal operation in the hospital from January to August 2017 were selected and randomly divided into the group B （levobupivacaine）, BB （levobupivacaine＋butollohanol） and BF （levobupivacaine ＋fentanyl）, 25 cases in each group.The analgesic onset time, analgesic complete time, analgesic persistent time, analgesic effect evaluation, adverse reaction occmTence and postoperative visual analogue scale （VAS） score were observed and recorded in each group.Results The analgesic onset time, analgesic complete time and analgesic persistent time in the group BB and BF were significantly superior to those in the group B, and the difference were statistically significant （P〈0.05） ;but the difference between the group BB and BF was not statistically significant （P〉0.05）.The VAS score in the group BB and BF was significantly lower than that in the group B, and the difference was statistically significant （P〈 0.05） ;the VAS score at postoperative 1-3 h in the group BB was significantly lower than that in the group BF, and the difference was statistically significant （P〈0.05）. Compared with the group B, the analgesic persistent time in the group BB and BF was significantly prolonged, and the difference was statistically significant （P〈0.05）.No serious cardiovascular and respiratory adverse reactions were observed in 3 groups.Conclusions Butorphanol and fentanyl as the adjuvant drugs of epidural anesthesia have the same safety, can ensure stable hemodynamics, can accelerates the anesthetic onset time and analgesic complete time, in which butollohanol can significantly prolongs post-operative analgesic effect.