不同浓度布托啡诺在骨科患者术后自控静脉镇痛中的效果比较  

Comparison of Patient-controlled Intravenous Analgesic Effects of Different Concentrations of Butorphanol after Orthopedic Surgery

作　　者：喻红辉[1] 罗爱林[1] 周碧云[1] 陈映红[1] 田玉科[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉学教研室,武汉430030

出　　处：《医药导报》2007年第9期999-1001,共3页Herald of Medicine

摘　　要：目的探讨布托啡诺在骨科手术后患者自控静脉镇痛(PCIA)中合理使用方法。方法ASAⅠ～Ⅱ级择期骨科手术患者100例,根据镇痛的药物不同随机分为4组,每组25例,即A组(芬太尼20μg.mL-1)、B1组(布托啡诺0.1 mg.mL-1)、B2组(布托啡诺0.2 mg.mL-1)和B3组(布托啡诺0.4 mg.mL-1)。患者入麻醉恢复室后接上镇痛泵,参数设置:负荷量2 mL,指令剂量2 mL,无背景输注,锁定时间10 min。评估PCIA后0,1,4,8,12和24 h患者疼痛评分和镇静评分,并记录各时间点的呼吸频率、血压、心率、指脉搏血氧饱和度、按压次数、镇痛药消耗量。疼痛评分采用视觉模拟评分(VAS)。结果PCIA后1和4 h,B1组VAS评分高于B2和B3组(P<0.05);并且在镇痛后5次评估中,B1组VAS>3分的发生率明显高于其他各组(P<0.05)。B3分组镇静评分在镇痛开始后高于其他各组,并且在1 h时差异有显著性(P<0.05);镇静过度(SS≥3)的发生率(21%)也高于其他各组,但差异无显著性。A组搔痒发生率12.5%,其他组患者均无搔痒发生;并且恶心呕吐发生率明显减少;A、B1、B2和B3组患者术后满意度优良率为88%,80%,92%和92%。结论在骨科手术后患者自控静脉镇痛中,0.2 mg.mL-1布托啡诺能取得满意的镇痛效果,相关不良反应较少。Objective To compare the analgesic effects of varying regimens of butorphanol on patient-controlled intravenous analgesia. Methods One hundred ASA Ⅰ-Ⅱ patients （32-67 years） scheduled for elective orthopedic surgery under general anesthesia were divided randomly into four groups, 25 patients in each group. Group A received fentanyl 20 μg·mL^-1 , group B1 , butorphanol 0.1 mg·mL^-1 , group B2 ,butorphanol 0.2 mg·mL^-1 and group B3 , butorphanol 0.4 mg·mL^-1. The patients received PCIA when they were sent to postoperative recovery room with loading dose 2 mL, bolus 2 mL, and lockout time 10 minutes. Pain scores, drug consumption, sedative scores, blood pressure, respiratoy rate, SpO2 and HR were assessed at 0, 1, 4, 8, 12 and 24 hours after analgesia. The patients were considered having analgesia as uncomfortable when their VAS 〉 3. Respiratory depression, nausea and vomiting, and pruritus were recorded. Results VAS in group B1 was significantly higher than that in groups B2 and B3 at 1 h and 4 h（ P 〈 0.05 ） ;moreover, the number of VAS 〉 3 was significantly higher in group B1 as compared with that in other groups（P 〈0.05）. In addition, we found that the sedative score in group B3 after the beginning of analgesia was higher than that in other groups, and the difference was significant at 1 h after analgesia（ P 〈 0.05 ）; furthermore, 21% patients （5/24） in group B3 had an incidence of over sedation with sedation scores≥3 ,which was higher than other groups but not significant. The patients in three butorphanol groups had higher sedative score with less respiratory depression, nausea , vomiting, and pruritus as compared with those in fentanyl group. Conclusion Butorphanol 0.2 mg·mL^-1 provides the optimum balance between pain relief and side effects following orthopedic surgery.

关 键 词：布托啡诺 芬太尼 镇痛 患者自控 

分 类 号：R971.2[医药卫生—药品] R969.4[医药卫生—药学]