布托啡诺在老年单侧膝关节置换术腰丛坐骨神经阻滞中的临床效果

Clinical Observation of Butorphanol for Lumbar Plexus Sciatic Nerve Block in Senile Patients Undergoing Unilateral Knee Arthroplasty

目的探讨布托啡诺在老年单侧膝关节置换术腰丛坐骨神经阻滞中的麻醉效果。方法选取2018年1月至2020年12月于山西医科大学第一医院麻醉科行择期腰丛坐骨神经阻滞下单侧膝关节置换术的50例老年患者,按照随机数字表法分为两组:布托啡诺组(于神经阻滞麻醉前静脉给予布托啡诺20μg/kg),舒芬太尼组(于神经阻滞麻醉前静脉给予舒芬太尼0.1μg/kg),每组25例。观察两组入室时、静脉给药即刻、神经阻滞操作即刻、切皮即刻、上止血带后60 min、放止血带即刻、术毕的平均动脉压和心率,于入室时和术毕测定桡动脉血浆皮质醇和去甲肾上腺素水平,以及各时间点视觉模拟评分(VAS)和Ramsay镇静评分,记录术中不良反应(恶心、干呕/呕吐、低血压、呼吸抑制、嗜睡等)的发生情况。结果舒芬太尼组不同时点平均动脉压、心率变化幅度较大,布托啡诺组不同时点平均动脉压、心率均较平稳,各指标时点间、组间和时点间交互作用比较差异均有统计学意义(P<0.01)。治疗前后布托啡诺组皮质醇、去甲肾上腺素变化的幅度小于舒芬太尼组,皮质醇、去甲肾上腺素的组间、时点间、组间和时点间的主效应差异有统计学意义(P<0.05或P<0.01)。两组各时点间VAS评分比较差异无统计学意义(P>0.05)。不同时点间Ramsay镇静评分的主效应差异有统计学意义(P<0.01);不考虑测量时间,两组间Ramsay评分的主效应差异有统计学意义(P<0.01);Ramsay镇静评分的组间和时点间存在交互作用(P<0.01),T_(2)~T_(5)时刻两组Ramsay镇静评分呈升高趋势,各时点布托啡诺组Ramsay镇静评分均高于舒芬太尼组。布托啡诺组和舒芬太尼组总不良反应发生率分别为20.0%(5/25)和40.0%(10/25),两组比较差异无统计学意义(P>0.05)。结论布托啡诺作为老年单侧膝关节置换术中腰丛坐骨神经阻滞的辅助药物,有助于减轻止血带反应、有效抑制应激反应、稳定血流动力学,且镇静、镇痛效果良好,患者舒适度较高。

Objective To investigate the clinical effect of butorphanol in lumbar plexus sciatic nerve block after unilateral knee arthroplasty in the elderly.Methods A total of 50 elderly patients who underwent unilateral knee arthroplasty under selective lumbar plexus sciatic nerve block in the Department of Anesthesiology of the First Hospital of Shanxi Medical University from Jan.2018 to Dec.2020 were included,and they were divided into two groups according to the random number table method:a butorphanol group(given butorphanol 20μg/kg intravenously before nerve block anesthesia),a sufentanil group(given sufentanil 0.1μg/kg intravenously before nerve block anesthesia),25 cases in each group.The mean arterial pressure and heart rate of the two groups were observed at the time of entering the operation room,immediately after intravenous administration,immediately after nerve block operation,immediately after skin cutting,60 min after placing tourniquet,immediately after tourniquet discharge and after operation.The plasma cortisol and norepinephrine levels of radial artery were measured at the time of entering the operation room and after operation,the visual analogue scale(VAS)and Ramsay sedation score at each time point,and the adverse reactions(nausea,retching/vomiting,hypotension,respiratory depression,drowsiness,etc.)were recorded.Results The changes of mean arterial pressure and heart rate at different time points in the sufentanil group were larger,while those in the butorphanol group were more stable.There were significant differences between time points,and interactions between groups and time points of different indexes(P<0.01).Before and after treatment,the changes of cortisol and norepinephrine in the butorphanol group were smaller than those in the sufentanil group.There were significant differences in the main effects of cortisol and norepinephrine between groups,time points,groups and time points(P<0.05 or P<0.01).There was no significant difference in VAS score between the two groups(P>0.05).The main effect difference of Ramsay sedation score at different time points was statistically significant(P<0.01);regardless of the measurement time,the main effect difference of Ramsay score between the two groups was statistically significant(P<0.01);there was interaction between Ramsay sedation score between groups and time points(P<0.01).Ramsay sedation score in the two groups increased from T_(2)to T_(5).Ramsay sedation score in the butorphanol group was higher than that in the sufentanil group at each time point.The total adverse reaction rates of the butorphanol group and the sufentanil group were 20.0%(5/25)and 40.0%(10/25),respectively,and there was no significant difference between the two groups(P>0.05).Conclusion As an auxiliary drug for lumbar plexus sciatic nerve block in the elderly unilateral knee arthroplasty,butorphanol helps to reduce tourniquet response,effectively inhibit stress response,stabilize hemodynamics,and has good sedative and analgesic effects,as well as a high degree of patient comfort.