酒石酸布托啡诺用于无痛胃肠镜检查的临床研究

Clinical study of butorphanol tartrate for painless gastroenteroscopy

目的:探讨不同时间点提前给予酒石酸布托啡诺对无痛胃肠镜检查患者的影响。方法:将行无痛胃肠镜检查的180例患者按照干预时间点不同分为观察组1、观察组2、观察组3和对照组,每组各45例,观察组1、观察组2和观察组3患者分别提前2、4、6 min予以静脉10~20μg/kg布托啡诺和2 mg/kg丙泊酚诱导,对照组予以0.1~5.0μg/kg舒芬太尼+2 mg/kg丙泊酚诱导。比较各组患者不同时间段生命体征、丙泊酚用量、麻醉效果、呼吸抑制、苏醒时间、术中及术后不良反应发生情况,比较各组检查后1、2、4、8 h的视觉模拟量表(VAS)评分。结果:各观察组丙泊酚首量与总量均低于对照组(P<0.05),且观察组1、观察组2和观察组3丙泊酚首量与总量依次逐渐减少(P<0.05),各组麻醉效果比较,差异无统计学意义(P>0.05);各观察组呼吸抑制发生率均低于对照组(P<0.05),苏醒时间均短于对照组(P<0.05),且苏醒时间比较:观察组1>观察组2>观察组3(P<0.05),观察组3体动发生率低于对照组(P<0.05),各观察组术中不良反应总发生率均低于对照组(P<0.05);各观察组检查后1、2、4 h的VAS评分均低于对照组(P<0.05),且:观察组1>观察组2>观察组3(P<0.05);各组术后嗜睡、恶心、呕吐不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:相比于提前2、4 min给药,酒石酸布托啡诺提前6 min给药对无痛胃肠镜检查患者麻醉效果最好,可有效减少丙泊酚用量,减轻呼吸抑制,缩短苏醒时间,镇痛效果最佳,且对患者生命体征影响小,安全性良好,该研究可为酒石酸布托啡诺的临床应用提供理论基础。

Objective:To explore the effects of different timing of butorphanol tartrate administration on patients undergoing painless gastroenteroscopy.Methods:180 patients who underwent painless gastroenteroscopy in the hospital were selected,and were divided into observation group 1,observation group 2,observation group 3,and control group according to the different intervention time points,45 cases in each group.The observation groups 1,2 and 3 were given 10-20μg/kg of butorphanol intravenously at 2,4 and 6 min in advance and then given 2 mg/kg of propofol induction,while the control group was given 0.1~5.0μg/kg of sufentanil and 2 mg/kg of propofol induction.The vital signs,dosage of propofol,anesthetic effect,respiratory depression,awakening time,intraoperative and postoperative adverse reactions of patients in different time periods,and Visual Analogue Scale(VAS)scores at 1,2,4 and 8 h after examination were compared among the groups.Results:The first dosage of propofol and total dosage of propofol in various observation groups were less than in control group(P<0.05),and the two dosages were gradually decreased in observation groups 1,2 and 3(P<0.05).There was no statistical significance in anesthesia effect among the groups(P>0.05).The incidence rate of respiratory depression in various observation groups was lower than that in control group(P<0.05),and the awakening time was shorter than that in control group(P<0.05),and the awakening time in observation groups 1,2 and 3 was gradually shortened(P<0.05).The incidence rate of body movement in observation group 3 was lower than that in control group(P<0.05),and the total incidence rate of adverse reactions in observation groups was lower than that in control group(P<0.05).The VAS scores in the four groups varied over time,the VAS scores in observation groups at 1,2 and 4 h after examination were lower than that in control group(P<0.05),and the VAS scores in observation groups 1,2 and 3 at 1,2 and 4 h after examination were gradually decreased(P<0.05).The differences in the incidence rates of adverse reactions of postoperative lethargy,nausea and vomiting were not statistically significant among the groups(P>0.05).Conclusion:Butorphanol tartrate administration at 6 min in advance has the best anesthetic effect on patients undergoing painless gastroenteroscopy compared to administration at 2 or 4 min in advance,and can effectively reduce the dosage of propofol,relieve the respiratory depression and shorten the awakening time.In addition,it has the best analgesic effect and small impact on vital signs of patients,with good safety.This method can provide scientific basis for clinical application.