静脉预注布托啡诺对老年全麻患者拔管期的效果研究

Research of effect by intravenous preliminary injection of butorphanol for extubation period in senile general anesthesia patients

目的 观察静脉预注布托啡诺对老年全身麻醉(全麻)患者拔管期的影响。方法 120例择期行全麻手术的老年患者,随机分为B1组、B2组、B3组和C组,各30例。B1组、B2组、B3组分别于麻醉诱导前5min静脉缓慢注入布托啡诺0.01、0.02、0.03mg/kg,C组于同一时间点静脉注入生理盐水10ml。比较麻醉诱导药物静脉注入前即刻(T1)、手术结束时(T2)、拔除导管时(T3)及拔除导管后5min(T4)时的各生理指标。记录拔管时(t0)及拔管后5min(t1)、10min(t2)、20min(t3)时的警觉镇静评分(OAA/S)和不良反应。结果 在T3时,B2组与B3组血糖、皮质醇和血管紧张素-Ⅱ低于C组和B1组(P<0.05)。在T2~T4时,B2组与B3组平均动脉压(MAP)、心率(HR)低于C组和B1组(P<0.05)。B2组t1、t2时OAA/S评分(2.20±0.63)、(1.30±0.48)分低于其他三组(P<0.05)。B2、B3组术后躁动发生率(6.7%、0)低于C组和B1组,B3组呼吸抑制、循环抑制、嗜睡、头晕发生率(20.0%、13.3%、30.0%、30.0%)高于C组和B1、B2组(P<0.05)。结论 0.02mg/kg剂量的布托啡诺可以使老年患者苏醒平稳,拔管期应激反应降低,术后镇静适度,无明显不良反应。

Objective To observe influence by intravenous preliminary injection of butorphanol onextubation period in senile general anesthesia patients. Methods A total of 120 senile patients receiving generalanesthesia operation were randomly divided into group B1, group B2, group B3 and group C, with 30 cases in eachgroup. Groups B1, B2, B3 received respectively intravenous injection of butorphanol by 0.01, 0.02, 0.03 mg/kg in5 min before anesthesia induction, and group C received 10 ml normal saline at the same time point. Comparisonof physical signs was taken right before intravenous injection of anesthesia induction drug (T1), at the end ofoperation (T2), during extubation (T3) and in 5 min after extubation (T4). Observer’s assessment of alertness/sedation (OAA/S) and adverse reactions were recorded during extubation (t0) and in 5 min (t1), 10 min (t2), 20 min(t3) after extubation. Results Groups B2 and B3 had lower blood glucose, cortisol and angiotensin-Ⅱ at T3 thangroups C and B1 (P<0.05). At T2~T4, groups B2 and B3 had lower mean arterial pressure (MAP) and heart rate (HR)than groups C and B1 (P<0.05). Group B2 had lower OAA/S scores at t1 and t2 as (2.20±0.63) and (1.30±0.48)points than the other three groups (P<0.05). Groups B2 and B3 had lower incidence of postoperative agitation (6.7%,0) than groups C and B1, while group B3 had higher incidences of respiratory depression, circulation inhibition,somnolence, and dizziness (20.0%, 13.3%, 30.0% and 30.0%) than those in groups C, B1 and B2 (P<0.05).Conclusion Implement of butorphanol by 0.02 mg/kg can stabilize recovery in senile patients, reduce stressreactions in extubation period, along with moderate postoperative sedation and no remarkable adverse reactions.