布托啡诺联合芬太尼应用于上腹部手术后患者自控静脉镇痛的临床观察  

Postoperative Intravenous Analgesia with Butorphanol Combined with Fentanly in Patients Underwent Upper Abdominal Surgery

作　　者：陈钢[1] 万里[2] 

机构地区：[1]武汉市黄陂区人民医院麻醉科,湖北武汉430300 [2]华中科技大学同济医学院附属同济医院麻醉科,湖北武汉430030

出　　处：《医学新知》2010年第1期28-31,共4页New Medicine

摘　　要：目的通过观察布托啡诺联合芬太尼用于上腹部手术后患者自控静脉镇痛的效果，探讨两种药物联合应用的安全性和有效性。方法60例ASAI-II级的择期上腹部手术患者随机分为3组，每组20例，即F组（20ug／ml芬太尼）、B组（0．15mg／ml布托啡诺）和FB组（10ug／ml芬太尼＋0．1mg／ml布托啡诺）。在关腹膜前连接镇痛泵并给予负荷量1ml，背景输注量0．5ml／h，指令剂量0．5ml，锁定时间5min。记录手术后1、4、8、12、24和48h患者VAS评分、镇静评分、呼吸频率、血氧饱和度、按压次数和镇痛药消耗量、不良反应的发生情况、患者对镇痛的总体满意度。结果B组患者在术后各个时点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FB组之间的VAS评分在各个时点镇痛评分差异没有统计学意义（P〉0．05）。与F组比较，B组和FB组镇静评分较高，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，FB组最高，F组略低于FB组。F组患者发生瘙痒（25．0％）、恶心呕吐（30．0％）的比例较高，B组的镇痛效果较差，但B组及FB组均无瘙痒、恶心呕吐的发生。结论布托啡诺联合芬太尼应用于上腹部手术后患者自控静脉镇痛，可取得优良的镇痛、镇静效果并明显减少芬太尼的不良反应，是一种科学、合理的联合用药方式。Objective To evaluate the efficacy and safety of patient -controlled intravenous analgesia of butorphanol combined with fentanly in patients underwent upper abdominal surgery. Methods 60 ASA I - II patients scheduled for elective upper abdominal surgery under general anesthesia were randomly allocated into three groups, each group including 20 patients. Group F received fentanyl 20ug/ml ,group B received butorphanol 0.15 mg/ml, group FB received fentanyl lOp.g/ml combined with butorphanol 0.1 mg/ml. PCIA was initiated just before the abdominal suturing at a loading dose of 1 ml, the continuous rate is 0.5ml/h, the bolus is 0. 5ml, and lockout time is 10 minutes. Analgesia and sedation grade were assessed and side effects were recorded. Results VAS in group B was significantly higher than that in group F and group FB at all time points, and there was no significant difference between group F and group FB ;The sedative scores in group B and FB were higher than that in group F, but no excess sedation was found in the former two groups. Moreover, patients in group B and FB were satisfied with sedation. There was no incidence of nausea, vomiting and pruritus in patients of group B and group FB, but these were very common in group F. Conclusion Butorphanol combined with fentanly can improve analgesia efficacy and reduce fentanly adverse incidence. It can provide a better balance between pain relief and side effects for patients with upper abdominal surgery.

关 键 词：布托啡诺 芬太尼 患者自控静脉镇痛 上腹部手术 

分 类 号：R614[医药卫生—麻醉学]