布托啡诺、芬太尼用于抑制瑞芬太尼致术后痛觉过敏临床研究  

A clinical research of the inhibitive effects of butorphanol and fentanyl on remifentanil-induced postoperative hyperalgesia

作　　者：仇澜[1,2] 陈晨[2] 洪涛[2] 戴体俊[3] 

机构地区：[1]徐州医学院研究生学院,江苏徐州221002 [2]常州市第一人民医院麻醉科,江苏常州213000 [3]徐州医学院麻醉药理学教研室,江苏徐州221002

出　　处：《徐州医学院学报》2010年第12期809-811,共3页Acta Academiae Medicinae Xuzhou

基　　金：国家自然科学基金(30872432;30471657;39970715);江苏省自然科学基金(BK2001143)

摘　　要：目的比较布托啡诺与芬太尼干预瑞芬太尼（remifentanil）复合丙泊酚（propofol）静脉全麻患者苏醒后痛觉过敏的效果,评价布托啡诺镇痛的有效性和安全性。方法选择丙泊酚复合瑞芬太尼静脉全麻下择期行腹腔镜下胆囊切除术患者50例,ASAⅠ~Ⅱ级,随机分为2组：芬太尼组（F组）关腹前冲洗腹腔时静脉注射芬太尼2μg/kg,布托啡诺组（B组）关腹前冲洗腹腔时静脉注射布托啡诺30μg/kg。观察：①诱导前（T1）、苏醒后即刻（T2）、苏醒后1 h（T3）、苏醒后6 h（T4）时点的VAS评分、Ramsay评分、收缩压（SBP）、舒张压（DBP）、心率（HR）、血氧饱和度（SpO2）、呼吸抑制的发生率;②手术时间、意识恢复时间（呼之睁眼时间）、拔管时间。结果①2组患者的手术时间、意识恢复时间和拔管时间的差异无统计学意义（P〉0.05）;②与F组相比,B组在T2、T3、T4的Ramsay评分明显占优（P〈0.05或P〈0.01）,苏醒后6 h（T4）的VAS评分优于F组（P〈0.05）;③B组呼吸抑制的发生率明显低于F组（P〈0.05）。结论布托啡诺较芬太尼可更安全、有效地预防丙泊酚复合瑞芬太尼静脉全麻后痛觉过敏的发生。Objective To compare the intervention effects of butorphanol and fentanyl on postoperative hyperalgesia in patients wakening from total intravenous anesthesia induced by remifentanil combined with propofol and evaluate the effectiveness and safety of butorphanol in analgesia.Methods 50 cases of ASA Ⅰ-Ⅱ patients scheduled for laparoscopic cholecystectomy under total intravenous anesthesia with propofol and remifentanil were randomized into 2 groups： fentanyl（F） group with intravenous injection of fentanyl 2 μg/kg before abdominal rinse and closure;butorphanol（B） group with intravenous injection of butorphanol 30 μg/kg before abdominal rinse and closure.Observations were made on the parameters： ① The VAS score,Ramsay score,systolic blood pressure（SBP）,diastolic blood pressure（DBP）,heart rate（HR）,saturation of peripheral oxygen（SpO2） and incidence of respiration inhibition at the time points including the time before anesthesia induction（T1）,time point of awakening（T2）,1 hour after awakening（T3）,6 hours after awakening（T4）;② Time of operation,time point of regaining consciousness or eye-opening,time of extubation.Results ① There were no significant statistical differences in time of operation,time of regaining consciousness and time of extubation between the two groups（P0.05）;② Compared with F group,B group had a significant advantage in Ramsay score at T2,T3 and T4（P0.05）.B group also had an advantage in VAS at 6 hours after awakening（P0.05）.③ B group has a significantly lower incidence of respiration inhibition than F group（P0.05）.Conclusion Compared with fentanyl,butorphanol is safer and more effective in preventing the incidence of hyperalgesia following total intravenous anesthesia induced by propofol in combination with remifentanil.

关 键 词：布托啡诺 芬太尼 瑞芬太尼 痛觉过敏 

分 类 号：R614.1[医药卫生—麻醉学]