布托啡诺超前镇痛联合硬膜外自控镇痛用于腹腔镜下子宫肌瘤剔除术后临床研究

Effect of Butorphanol Preemptive Analgesia Combined with Patient-Controlled Epidural Analgesia on Pain Degree and Oxidative Stress in Patients Undergoing Laparoscopic Myomectomy

目的探讨布托啡诺超前镇痛联合硬膜外自控镇痛对腹腔镜下子宫肌瘤剔除术后患者的疼痛程度及氧化应激水平的影响。方法选取河北省廊坊市妇幼保健院2018年4月至2020年4月收治的行腹腔镜下子宫肌瘤剔除术患者104例,随机分为观察组和对照组,各52例。两组患者均予硬膜外自控镇痛疗法,观察组患者加用布托啡诺治疗。结果观察组患者术后2,6,12,24 h时视觉模拟评分均显著低于对照组(P<0.05);观察组患者术后的阿片类镇痛药物用量、自控镇痛总次数均显著低于对照组(P<0.05);观察组患者术后24 h的氧化应激指标(C反应蛋白、皮质醇、去甲肾上腺素)水平均显著低于对照组(P<0.05);观察组患者生活质量量表各维度的评分均显著高于对照组(P<0.05);观察组和对照组不良反应发生率相当(17.65%比10.20%,P>0.05)。结论布托啡诺超前镇痛联合硬膜外自控镇痛用于腹腔镜下子宫肌瘤剔除术后镇痛效果较好,能降低患者的术后疼痛感与应激反应、减少镇痛药物用量、改善生活质量,且安全性较好。

Objective To investigate the effect of butorphanol preemptive analgesia combined with patient-controlled epidural analgesia(PCEA)on the pain degree and oxidative stress levels in patients undergoing laparoscopic myomectomy.Methods A total of 104 patients underwent laparoscopic myomectomy in the Langfang Maternal and Child Health Hospital from April 2018 to April 2020 were selected and randomly divided into the observation group and the control group,52 cases in each group.The patients in the two groups were given PCEA,on this basis,the patients in the observation group were given butorphanol for preemptive analgesia.Results The visual analogue scale(VAS)scores in the observation group at 2,6,12 and 24 h after the operation were significantly lower than those in the control group(P<0.05).The dosage of opioid analgesics and the total times of PCEA in the observation group were significantly lower than those in the control group(P<0.05).The levels of oxidative stress indexes[C-reactive protein(CRP),cortisol(COR)and norepinephrine(NE)]in the observation group at 24 h after the operation were significantly lower than those in the control group(P<0.05).The scores of each dimension of the SF-36 quality of life(QOL)scale in the observation group were significantly higher than those in the control group(P<0.05).The incidence of adverse reactions in the observation group was similar to that in the control group(17.65%vs.10.20%,P>0.05).Conclusion The application of butorphanol preemptive analgesia combined with PCEA in patients undergoing laparoscopic myomectomy has good analgesic effect and safety,which can significantly reduce the postoperative pain,stress response,and the dosage of analgesic drugs,and improve the QOL of patients.