不同剂量布托啡诺在腹腔镜妇科手术中的应用

Application of different doses of butorphanol in laparoscopic gynecological surgery

目的探讨不同剂量布托啡诺对腹腔镜妇科手术患者术后镇静镇痛效果、苏醒期质量及应激反应的影响。方法采用随机数字表法将96例腹腔镜妇科手术患者分为A、B、C组,各32例。术前15 min,A组给予10μg·kg^(-1)布托啡诺,B组给予20μg·kg^(-1)布托啡诺,C组给予30μg·kg^(-1)布托啡诺治疗。3组均随访至术后24 h。比较3组苏醒期质量,术后2、6、12、24 h镇静镇痛效果,术前、术后24 h应激反应,术后24 h期间不良反应发生情况。结果C组苏醒时间、拔管时间、麻醉后监测治疗室(PACU)内停留时间长于A组、B组(P<0.05)。术后2、6、12 h 3组静息状态、活动状态数字分级法(NRS)评分呈升高趋势,术后24 h静息状态、活动状态NRS评分高于术后2、6 h,低于术后12 h(P<0.05);术后12、24 h B组、C组静息状态NRS评分低于A组(P<0.05);术后6、12、24 h B组、C组活动状态NRS评分低于A组(P<0.05);2组术后多个时间点Ramsay镇静评分差异无统计学意义,均在2分以上(P>0.05)。与术前比较,术后24 h血清皮质醇(Cor)、去甲肾上腺素(NE)、血糖(BG)水平升高,C组、B组低于A组(P<0.05)。治疗期间,C组不良反应总发生率高于B组、A组(P<0.05)。结论20μg·kg^(-1)布托啡诺对腹腔镜妇科手术患者术后镇静镇痛效果良好,未影响苏醒期质量,可缓解应激反应,安全性高,具有应用价值。

Objective To explore the effects of different doses of butorphanol on postoperative sedation and analgesia,quality of recovery period and stress response in patients undergoing laparoscopic gynecological surgery.Methods A total of 96 patients undergoing laparoscopic gynecological surgery were selected and divided into Group A,Group B and Group C according to random number table method,with 32 cases in each group.At 15 minutes before surgery,Group A was treated with 10μg·kg^(-1) butorphanol,Group B was treated with 20μg·kg^(-1) butorphanol,and Group C was treated with 30μg·kg^(-1) butorphanol.All three groups were followed up until 24 hours after surgery.The quality of recovery period,sedation and analgesia effects at 2,6,12 and 24 hours after surgery,stress response before surgery and 24 hours after surgery,and the incidence of adverse reactions during the first 24 hours after surgery of three groups were compared.Results The recovery time,extubation time and stay time in postanesthesia care unit(PACU)in Group C were longer than those in Group A and Group B(P<0.05).The Numeric Rating Scale(NRS)scores of resting state and activity state in three groups showed the increasing trend at 2,6 and 12 hours after surgery,the NRS scores of resting state and activity state at 24 hours after surgery were higher than those at 2 and 6 hours after surgery,but lower than those at 12 hours after surgery(P<0.05).At 12 and 24 hours after surgery,NRS scores of resting state in Group B and Group C were lower than those in Group A(P<0.05).At 6,12 and 24 hours after surgery,the NRS scores of activity state in Group B and Group C were lower than those in Group A(P<0.05).There was no statistically significant difference in scores of Ramsay sedation at multiple postoperative time points between two groups,all scores were above 2 points(P>0.05).Compared with before surgery,the serum levels of cortisol(Cor),norepinephrine(NE)and blood glucose(BG)at 24 hours after surgery increased,and Group B and Group C were lower than Group A(P<0.05).During treatment,the incidence of adverse reactions in Group C was higher than that in Group B and Group A(P<0.05).Conclusion 20μg·kg^(-1) butorphanol has good effect on postoperative sedation and analgesia in the patients undergoing laparoscopic gynecological surgery,without affecting the quality of recovery period,can relieve stress response,has high safety,and has application value.