布托啡诺联合芬太尼应用于开胸手术后患者自控静脉镇痛  

Postoperative intravenous analgesia with butorphanol combined with fentanyl in patients underwent thoracic surgery

作　　者：万里[1] 张传汉[1] 王学仁[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：《中国医师进修杂志》2008年第5期1-3,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的通过观察布托啡诺联合芬太尼用于开胸手术后患者自控静脉镇痛的效果，探讨两种药物复合应用的安全性。方法90例ASA分级Ⅰ-Ⅱ级的择期开胸手术患者，随机分为三组，每组各30例，即B组（0．15mg／ml布托啡诺）、F组（20阻洲芬太尼）和BF组（0．1mg／ml布托啡诺＋10μg／ml芬太尼）。在手术缝合皮肤前接镇痛泵，记录手术后1、4、8、12、24和48h患者镇痛评分、镇静评分、Bp、HR、R、SpO2、按压次数、镇痛药物消耗量、不良反应的发生情况、患者对镇痛的总体满意度等。结果B组患者在术后1、4、8和12h的镇痛评分均明显高于其他两组，差异有统计学意义（P〈0．05），而F组与BF组镇痛评分在各个时间点比较差异均无统计学意义（P〉0．05）。与F组比较，B组和BF组1、4、8和12h镇静评分较高，但无过度镇静的发生。从患者对镇痛的总体满意度调查看，B组满意度最低，BE组最高，F组略低于BE组。F组患者发生皮肤瘙痒（16．7％）、恶心呕吐（23．3％）的比例较高，B组的镇痛效果较差，但B组及BF组均无皮肤瘙痒的发生。结论布托啡诺联合芬太尼应用于开胸术后患者自控静脉镇痛安全有效，不良反应少，布托啡诺适度的镇静作用成为患者满意度高的主要因素。Objective To evaluate the efficacy for patient controlled intravenous analgesia（PCIA） of butorphanol combined with fentanyl in the patients underwent thoracic surgery. Methods Ninety ASA Ⅰ-Ⅱ patients scheduled for elective thoracic surgery under general anesthesia were randomly allocated into three groups, each group including 30 patients. Group B received butorphanol 0.15 mg/ml, group F received fentanyl 20 μ g/ml, group BF received buiorphanol 0.1 mg/ml combined with fentanyl 10 μ g/ml. PCIA was initiated just before the beginning of skin suturing with a loading dose of 1 ml, continuous rate was 1 ml/h, bolus was 0.5 ml, and lockout time was 10 minutes. VAS, sedative scores, respiratory frequency, saturation of blood oxygen, press times, pain-killer dose, side effects and satisfaction to analgesia at 1,4, 8, 12, 24 and 48 hours after operation were recorded. Results VAS in group B was significantly higher than that in group F and group BF at 1,4,8 and 12 hours after operation （P 〈 0.05）, and there was no significant difference between group F and group BF （P〉 0.05）. The sedative scores in group B and BF were higher than that in group F, but no excess sedation was found in the former two groups. At the same time, the satisfaction to analgesia was the lowest in group B, the highest in group BF and higher in group F. There were no incidence of nausea, vomiting and pruritus in group B and group BF, but pruritus was 16.7% and nausea, vomiting was 23.3% in group F. Conclusions Butorphanol combined with fentanyl can improve analgesia efficacy and reduce fentanyl adverse incidence. It can provide the better balance between pain relief and side effects after thoracic surgery.

关 键 词：镇痛 病人控制 胸外科手术 布托啡诺 芬太尼 

分 类 号：R614[医药卫生—麻醉学]