不同剂量布托菲诺复合舒芬太尼对上腹部手术术后镇痛的影响

EEffect of Different Doses of Butorphanol in Combination with Sufentanil on Postoperative Analgesia for Upper Abdominal Surgery

目的探讨不同剂量布托菲诺复合舒芬太尼对上腹部手术术后镇痛的影响。方法选择2017年4—11月中国医科大学附属盛京医院择期行上腹部手术患者60例,美国麻醉医师协会分级Ⅰ或Ⅱ级。按照随机数字法分为3组,每组20例,术毕使用患者静脉自控镇痛,患者静脉自控镇痛配置方法三组分别为:S组(舒芬太尼2μg/kg)、SB1组(舒芬太尼2μg/kg+布托啡诺0. 05 mg/kg)、SB2组(舒芬太尼2μg/kg+布托啡诺0. 1 mg/kg)。记录三组患者术后2、6、12、24、48 h安静时的疼痛视觉模拟评分(VAS)评分、Ramsay镇静评分,记录患者按压镇痛泵次数、补救药物用量及例数。记录三组术后不良反应(恶心呕吐、嗜睡、呼吸抑制)的发生情况。结果术后2 h SB1组、SB2组镇痛效果起效均较S组快,SB1组和SB2组各时点VAS评分均显著低于S组,三组在组间、时点间比较差异均有统计学意义(P <0. 01),但组间和时点间交互作用比较差异无统计学意义(P> 0. 05)。S组Ramsay评分在术后呈先升高后降低的趋势。SB1组和SB2组Ramsay评分在24 h内较为稳定,在48 h开始降低,各时点均显著高于S组,SB2组Ramsay评分高于SB1组。三组Ramsay评分在组间、时点间和组间和时点间交互作用比较差异均有统计学意义(P <0. 01)。SB2组和SB1组按压镇痛泵的次数明显少于S组(P <0. 05),哌替啶使用总量显著低于S组(P <0. 05),三组补救镇痛率比较差异无统计学意义(P> 0. 05)。结论舒芬太尼2μg/kg+布托啡诺0. 05 mg/kg用于上腹部手术术后镇痛能显著降低患者术后疼痛。

Objective To observe the effect of different doses of butorphanol in combination with sufentanil on postoperative analgesia for upper abdominal surgery.Methods Sixty patients admitted to Shengjing Hospital from Apr.2017 to Nov.2017,with American Society of AnesthesiologistsⅠorⅡundergoing elective upper abdominal surgery under general anesthesia and using patient control intravenous analgesia after surgery were randomly divided into three groups according to random number ordering,20 patients each.The drugs used in patient control intravenous analgesia:in group S:sufentanil 2μg/kg;in group SB1:sufentanil 2μg/kg+butorphanol 0.05 mg/kg;in group SB2:sufentanil 2μg/kg+butorphanol 0.1 mg/kg.The visual analog scale(VAS)scores and Ramsay sedation scale scores were record at 2,6,12,24 and 48 h after surgery,also the adverse reactions such as nausea,vomiting and drowsiness,respiration depress after surgery were recorded.Results The onset time in either group SB1 or SB2 was faster than in group SB 2 h after operation,but VAS scores were lower in group SB1 and SB2 than in group S at different time intervals,the differences were statistically significant among the three groups and at different time points(P<0.01),but there were no significant differences in interaction between groups and time points(P>0.05).Ramsay scores increased first and then decreased in group S.The scores were stable within 24 h,but decreased at 48 h in both group SB1 and SB2,and were higher than group S at every time interval,moreover,the scores in group SB2 were higher those than in group SB1.The Ramsay score saw significant differences between groups,time intervals,and interaction of group and time interval(P<0.01).Pressing pump times in group SB1 and SB2 were significantly less than that of group S(P<0.05),the total usage of pethidine was significantly lower in group SB1 and SB2 than in group S(P<0.05),there was no significant difference in the rate of salvage analgesia among the three groups(P>0.05).Conclusion Sufentanil 2μg/kg+butorphanol 0.05 mg/kg for PCIA in the patients with upper abdominal surgery under general anesthesia can significantly alleviate the degree of pain and can be safely used in clinical.