布托啡诺不同给药方式的超前镇痛在老年患者腹腔镜胆囊手术中安全性和有效性比较

Comparison of safety and efficacy of preemptive analgesia with different administration methods of butorphanol in elderly patients undergoing laparoscopic cholecystectomy

目的比较布托啡诺不同给药方式的超前镇痛在老年患者腹腔镜胆囊手术中安全性和有效性。方法选择2021年6月-2022年6月荆门市中心医院进行全身麻醉下腹腔镜胆囊切除术的老年患者150例,按照随机数字表法分为对照组(C组)、静脉注射组(Ⅳ组)和鼻喷给药组(NS组),每组50例。C组、Ⅳ组和NS组在术前10 min分别静脉注射等体积的生理盐水、静脉注射布托啡诺0.5 mg,鼻喷给予布托啡诺0.5 mg。记录患者给药前(T_(0))、插管即刻(T_(1))、气腹即刻(T_(2))和拔管即刻(T_(3))的HR和MAP。比较3组不良反应发生情况、患者术后补救镇痛率、患者停药后的苏醒时间及VAS评分。结果与同组T_(0)相比,C组在T_(1)-T_(3)时刻HR均显著加快,MAP均显著升高(P<0.05)。与C组相比,Ⅳ组和NS组在T_(1)-T_(3)时刻HR均显著加快,MAP均显著升高(P<0.05)。与C组相比,Ⅳ组和NS组术后注射痛、呛咳、恶心、呕吐发生率、术后舒芬太尼追加率均显著降低(P<0.05),Ⅳ组头晕发生率显著高于C组和NC组(P<0.05)。与C组相比,Ⅳ组和NS组苏醒时刻的VAS评分显著降低(P<0.05)。结论术前给予布托啡诺超前镇痛,术中血流动力学平稳,可减少术后阿片类药物的应用且术后不良反应少,布托啡诺静脉注射后部分患者出现头晕,而鼻喷给药未见头晕发生患者。

Objective To compare the safety and efficacy of preemptive analgesia with different administration methods of butorphanol in elderly patients undergoing laparoscopic cholecystectomy.Methods 150 elderly patients undergoing laparoscopic cholecystectomy under general anesthesia in Central Hospital of Jingmen City from June 2021 to June 2022 were selected.They were divided into control group(group C),intravenous injection group(group Ⅳ)and nasal spray group(group NS)according to random number table method,with 50 cases in each group.10 minutes before surgery,group C,groupⅣ,and group NS were given an equal volume of normal saline via intravenous injection,0.5 mg of butorphanol via intravenous injection,and 0.5 mg of butorphanol via nasal spray,respectively.HR and MAP of patients were recorded before administration(T_(0)),immediately after intubation(T_(1)),immediately after pneumoperitoneum(T_(2))and immediately after extubation(T_(3)).The incidence of adverse reactions,rate of postoperative salvage analgesia,recovery time after discontinuation of medication,and VAS score were compared among the three groups.Results Compared with the same group at T0,the group C showed a significant increase in HR and MAP at T_(1)-T_(3)(P<0.05).Compared with the group C,both groupⅣand group NS showed a significant increase in HR and MAP at T_(1)-T_(3)(P<0.05).Compared with the group C,the incidence of postoperative injection pain,coughing,nausea,vomiting,and the rate of postoperative addition of sufentanil in the groupⅣand group NS decreased significantly(P<0.05).The incidence of dizziness in the groupⅣwas significantly higher than that in the group C and group NC(P<0.05).Compared with the group C,the VAS scores at the moment of awakening in the groupⅣand group NS were significantly lower(P<0.05).Conclusion Preoperative preemptive analgesia with butorphanol can make the intraoperative hemodynamics of patients stable,reduce the application of postoperative opioids,and reduce postoperative adverse reactions.Some patients experienced dizziness after intravenous butorphanol injection,but no patients experienced dizziness after nasal spray administration.