布托啡诺用于瑞芬太尼麻醉妇科腹腔镜手术后镇痛的观察  

Effect of Butorphanol in Postoperative Analgesia on Patients Undergone Gynecologic Laparoscopic Surgery with Remifentanil Anesthesia

作　　者：鲁爱民[1] 任俏[1] 连铁[1] 黄龙[1] 

机构地区：[1]广东省深圳市罗湖区人民医院麻醉科,深圳518001

出　　处：《中国微创外科杂志》2010年第10期915-918,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的观察布托啡诺在防治瑞芬太尼麻醉妇科腹腔镜手术后疼痛的有效性。方法 60例择期妇科腹腔镜手术,按手术先后顺序分为B1、B2、S 3组。气管插管以微量泵持续输注丙泊酚和瑞芬太尼行全凭静脉麻醉。术毕前30 min B1、B2组分别静滴布托啡诺0.01 mg/kg、0.02 mg/kg,S组静滴舒芬太尼0.2μg/kg。记录拔管时、拔管后30 min、1 h、2 h Ramsay镇静评分(Ramsay sedation score,RSS)和疼痛视觉模拟评分(visual analogue scale,VAS)。记录拔管时间及术前、拔管时、拔管后30 min、1 h、2 h MAP、HR、RR,观察术后不良反应发生情况。结果 B1组拔管时和拔管后30 min,HR显著高于B2组(q=8.311,P<0.05;q=5.263,P<0.05)和S组(q=8.957,P<0.05;q=6.073,P<0.05)。拔管后30 min,B1组MAP显著低于B2、S 2组(q=3.959,P<0.05;q=3.393,P<0.05)。S组4例发生呼吸抑制,明显多于B1、B2组(χ2=17.549,P=0.000;χ2=21.232,P=0.000)。3组恶心呕吐、寒战的发生率无显著差异(P>0.05)。VAS评分B1组拔管时、拔管后30 min显著高于B2(q=4.228,P<0.05;q=3.648,P<0.05)、S组(q=4.363,P<0.05;q=4.115,P<0.05),但B2、S组各时点VAS评分无统计学差异(P>0.05)。B2组各时点RSS评分显著高于S组(q=5.973,8.030,9.251,9.339,P<0.05),但B1组各时点RSS评分与S组无统计学差异(P>0.05)。结论布托啡诺0.02 mg/kg能够安全有效地用于瑞芬太尼麻醉妇科腹腔镜术后镇痛。Objective To observe the efficacy of butorphanol on postoperative pain in patients undergone gynecologic laparoscopic surgery with remifentanil anesthesia. Methods Totally 60 cases of elective gynecologic laparoscopic surgery were randomly divided into B1,B2,and S groups.General anesthesia was carried out with tracheal intubation with continuous infusion of propofol and remifentanil.Thirty minutes before the end of the surgery,B1,B2 groups received intravenous infusion of butorphanol at a dose of 0.01 mg/kg and 0.02 mg/kg,respectively;while S group received sufentanil 0.2 μg/kg instead.We recorded Ramsay sedation score（RSS） and pain visual analogue scale（VAS） at extubation,and 30 minutes,1 hour and 2 hours after the extubation in the three groups,as well as MAP,HR,RR,and postoperative complications. Results Group B1 showed significantly higher HR than groups B2（q=8.311,P0.05;q=5.263,P0.05） and S（q=8.957,P0.05;q=6.073,P0.05） at extubation and 30 minutes post-extubation,but significantly lower MAP at 30 minutes post-extubation（q=3.959,P0.05;and q=3.393,P0.05 compared with groups B2 and S respectively）.In group S,4 patients developed respiratory depression,that was significantly more than groups B1 and B2（χ2=17.549,P=0.000 and χ2=21.232,P=0.000,respectively）.Whereas,no significant difference was found in the rates of vomiting and nausea,and chill among the three groups（P0.05）.The B1 group showed significantly higher VAS at extubation and 30 minutes after the extubation than groups B2（q=4.228,P0.05;q=3.648,P0.05） and S（q=4.363,P0.05;q=4.115,P0.05）,while no significant difference was observed between groups B2 and S（P0.05）.At all time points,B2 group showed significantly higher RSS than S group（q=5.973,8.030,9.251,9.339,P0.05）,while no such difference was detected between groups B1 and S（P0.05）. Conclusion A dose of 0.02 mg/kg butorphanol is safe and effective for postoperative analgesia on patients undergone gynecologic laparoscopic surgery with remifentanil anesthes

关 键 词：布托啡诺 瑞芬太尼 腹腔镜 镇痛 

分 类 号：R614.2[医药卫生—麻醉学]