不同剂量布托啡诺预处理对罗库溴铵注射痛的影响

Effect of different doses of butorphanol pretreatment on injection pain of rocuronium

目的观察预先使用不同剂量的布托啡诺对罗库溴铵注射痛的影响。方法选择2019年9月至2020年3月河南大学第一附属医院拟行全身麻醉的择期手术患者140例为研究对象,采用计算机随机数字表法将患者分为生理盐水组、10μg·kg-1布托啡诺组、20μg·kg-1布托啡诺组及30μg·kg-1布托啡诺组,每组35例。麻醉诱导前生理盐水组及10、20、30μg·kg-1布托啡诺组患者分别静脉注射生理盐水5 mL及布托啡诺10、20、30μg·kg-1(溶入5 mL生理盐水),5 min后各组患者静脉注射罗库溴铵0.6 mg·kg-1。记录患者入手术室时(T 0)、注射罗库溴铵前(T 1)、注射罗库溴铵后(T 2)的平均动脉压(MAP)、心率(HR);评估各组患者罗库溴铵注射痛、缩肢反应情况;观察注射布托啡诺后不良反应发生情况及术后24 h注射部位疼痛、红肿、水泡、斑块、过敏等不良反应。结果20、30μg·kg-1布托啡诺组患者T 1时的MAP、HR显著低于T 0时(P<0.05)。生理盐水组和10μg·kg-1布托啡诺组患者T 2时的MAP、HR均显著高于T 1时(P<0.05)。T 1时,30μg·kg-1布托啡诺组患者MAP显著低于生理盐水组(P<0.05);T 2时,20μg·kg-1布托啡诺组与30μg·kg-1布托啡诺组患者MAP、HR显著低于生理盐水组(P<0.05)。10μg·kg-1布托啡诺组患者罗库溴铵注射痛及缩肢反应发生率与生理盐水组比较差异无统计学意义(χ2=1.607、1.806,P>0.05)。20μg·kg-1布托啡诺组、30μg·kg-1布托啡诺组罗库溴铵注射痛及缩肢反应发生率均显著低于生理盐水组和10μg·kg-1布托啡诺组(χ2=14.570、7.295、27.766、13.027,27.680、17.014、36.187、24.476,P<0.05);20μg·kg-1布托啡诺组、30μg·kg-1布托啡诺组中重度罗库溴铵注射痛发生率显著低于生理盐水组(χ2=23.333、28.810,P<0.05)。20μg·kg-1布托啡诺组、30μg·kg-1布托啡诺组患者罗库溴铵注射痛及缩肢反应发生率比较差异无统计学意义(χ2=0.952、1.148,P>0.05)。30μg·kg-1布托啡诺组不良反应发生率显著高于生理盐水组、10μg·kg-1布托啡诺组及20μg·kg-1布托啡诺组(χ2=14.483、11.430、5.185,P<0.05),生理盐水组、10μg·kg-1布托啡诺组、20μg·kg-1布托啡诺组患者之间不良反应发生率比较差异均无统计学意义(χ2=1.014、4.242、1.938,P>0.05)。术后24 h,各组患者注射部位均无疼痛、红肿、水泡、斑块、过敏等不良反应。结论布托啡诺能有效减轻罗库溴铵注射痛,20μg·kg-1预给剂量相对理想。

Objective To observe the effect of different doses of butorphinol pretreatment on the injection pain of rocuronium.Methods A total of 140 patients who underwent elective surgery under general anesthesia in the First Affiliated Hospital of Henan University from September 2019 to March 2020 were selected as the research objects.The patients were randomly divided into the normal saline group,10μg·kg-1 butorphanol group,20μg·kg-1 butorphanol group and 30μg·kg-1 butorphanol group by using the computer random number table method,with 35 cases in each group.Before induction of anesthesia,the patients in the normal saline group and the 10,20,30μg·kg-1 butorphanol group received intravenous injection of 5 mL of normal saline and 10,20,30μg·kg-1 of butorphanol(dissolved in 5 mL saline)respectively,5 minutes later,the patients in each group were injected intravenously with rocuronium 0.6 mg·kg-1.The average arterial pressure(MAP)and heart rate(HR)of patients at entering the operating room(T 0),before rocuronium injection(T 1)and after rocuronium injection(T 2)were recorded;the rocuronium injection pain and limb shrinkage reactions of patients in each group were evaluated;the adverse reactions of patients in each group were observed after injection of butorphanol,and other adverse reactions at the injection site were observed at 24 h after operation.Results The MAP and HR of patients in the 20,30μg·kg-1 butorphanol groups at T 1 were significantly lower than those at T 0(P<0.05).The MAP and HR of patients in the normal saline group and the 10μg·kg-1 butorphanol group at T 2 were significantly higher than those at T 1(P<0.05).The MAP of patients in the 30μg·kg-1 butorphanol group was significantly lower than that in the normal saline group at T 1(P<0.05);the MAP and HR of patients in the 20,30μg·kg-1 butorphanol group were significantly lower than those in the saline group at T 2(P<0.05).There was no significant difference in the rocuronium injection pain and the incidence of limb reduction reaction between the 10μg·kg-1 butorphanol group and the normal saline group(χ2=1.607,1.806;P>0.05).The rocuronium injection pain and the incidence of limb reduction reaction of patients in the 20,30μg·kg-1 butorphanol group were significantly lower than those in the normal saline group and the 10μg·kg-1 butorphanol group(χ2=14.570,7.295,27.766,13.027,27.680,17.014,36.187,24.476;P<0.05);the incidence of severe rocuronium injection pain in the 20,30μg·kg-1 butorphanol group was significantly lower than that in the normal saline group(χ2=23.333,28.810;P<0.05).There was no significant difference in the rocuronium injection pain and the incidence of limb reduction reaction between the 20μg·kg-1 butorphanol group and 30μg·kg-1 butorphanol group(χ2=0.952,1.148;P>0.05).The incidence of adverse reactions in the 30μg·kg-1 butorphanol group was significantly higher than that in the normal saline group and the 10,20μg·kg-1 butorphanol group(χ2=14.483,11.430,5.185;P<0.05).There was no statistically significant difference in the incidence of adverse reactions of patients among the normal saline group,10,20μg·kg-1 butorphanol group(χ2=1.014,4.242,1.938;P>0.05).At 24 h after operation,there was no pain,redness,swelling,blisters,plaques,allergies and other adverse reactions at the injection site of patients in each group.Conclusion Butorphanol can effectively reduce the rocuronium injection pain.The pre-administration dose of 20μg·kg-1 of butorphanol is relatively ideal.