布托啡诺与吗啡用于腹部手术后硬膜外镇痛效果的比较  

The comparison of efficacy between butorphanol and morphine in postoperative epidural analgesia for patients undergoing abdominal surgery

作　　者：蒋海[1] 张辉[2] 庞婷[1] 陈丽红[1] 靳三庆[1] 

机构地区：[1]中山大学附属第六医院麻醉科,广州510655 [2]中山大学附属第一医院麻醉科

出　　处：《国际麻醉学与复苏杂志》2010年第5期413-416,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：目的研究不同剂量布托啡诺用于腹部手术患者术后硬膜外镇痛的效果及副作用，并与吗啡硬膜外镇痛进行比较。方法择期腹部手术ASAⅠ～Ⅱ级患者75例，按术后镇痛用药不同随机分为3组（n=25）：M组（吗啡12mg＋0．1％罗哌卡因共150ml），B1组（布托啡诺9mg＋0．1％罗哌卡因共150ml），B2组（布托啡诺12mg＋0．1％罗哌卡因共150ml）。负荷量为0．25％罗哌卡因5ml加吗啡2mg或布托啡诺2mg，持续背景输注剂量均为1．5ml／h，按压追加药量均为2ml／次，按压锁定时间20min。观察记录3组患者术中芬太尼的总药量；术后1、4、8、12、18、24、36、48h各时间点的疼痛视觉模拟评分（painvisual analogue scores，VAS）；术后1、4、8、12h的警觉镇静评分observer’s assessment of alertness／sedation scores，OAMS）；术后48h内按压总次数及总药量；肛门排气时间；术后镇痛副作用（头痛头晕、嗜睡、呼吸抑制、搔痒、恶心、呕吐、腹胀）的发生情况。结果术后4h时间点B1组VAS评分为2．8±1．0，高于M组的2．0±0．7及B2组的2．0±0．9（P〈0．05），其余时间点3组间比较差异无统计学意义（P〉0．05）。M组的头痛头晕、恶心、呕吐，腹胀，搔痒发生例数分别为3、11、7、4、5例，而B1组仅有1例头痛头晕，B2组有2例头痛头晕，1例恶心，发生率均低于M组（P〈0．05）。3组患者术中芬太尼的总药量、48h内按压总次数及总药量、术后不同时间点OAA／S评分及肛门排气时间的比较差异无统计学意义（P〉0．05）。结论每天3mg～4mg布托啡诺应用于腹部手术后硬膜外镇痛，镇痛效果确切，且其副作用发生率较吗啡明显降低。Objective To compare the efficacy and complications between butorphanol and morphine in postoperative epidural analgesia for patients undergoing abdominal surgery. Methods Seventy-five patients undergoing abdominal surgery were randomly divided into three groups （n=25） ： group M （morphine 12 mg in 0.1% ropivacaine solution 150 ml）, group B 1 （butorphanol 9mg in 0.1% ropivacaine solution 150 ml）, group B2 （butorphanol 12 mg in 0.1% ropivacaine solution 150 ml）. Epidural loading dose was 0.25% ropivacaine 5 ml with morphine 2 mg or butorphanol 2 mg according to different groups, and maintenance dose was continuously given at a rate of 1.5 ml/h immediately after the loading dose. PCA was set as 2 ml per bolus and 20 min lock time. VAS （visual analogue scores） was recorded at postoperative 1,4,8,12, 18,24,36,48 h and OAA/S（Observer＇s Assessment of Alertness/Sedation scores）was recorded at postoperative 1,4,8,12h. Total dosage of fentanyl, times of PCA, and the time to flatus were also recorded. Complications （headache and dizziness, somnolence, respiration depress, nausea, vomiting, abdominal distention, pruritus）were observed in three groups. Results VAS in group B1 was（2.8±1.0） at postoperative 4 h,which was higher than that in group M（2.0±0.7） and B2（2.0±0.9） （P〈 0.05 ）. There were no significant differences of total dosage of fentanyl, OAA/S, PCA times and the time to flatus among three groups （P〉 0.05）. The case of headache and dizziness, nausea, vomiting, abdominal distention and pruritus in group M were 3,11,7,4,5, significant higher than group B1 and B2 （P〈0.05）. Conclusion It is concluded that butorphanol 3 mg^4 mg per day is effective in postoperative epidural analgesia for patients undergoing abdominal surgery, and lower incidence of side effects compared with morphine.

关 键 词：布托啡诺 术后镇痛 硬膜外 腹部手术 

分 类 号：R614[医药卫生—麻醉学]