不同药物治疗全麻患者苏醒期躁动的疗效比较  

Effects of different analgesics on postoperative agitation in adult patients after general anesthesia

作　　者：高峰[1] 杨辉[1] 曹菲[1] 田学愎[1] 许爱军[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,武汉市430030

出　　处：《临床麻醉学杂志》2011年第2期109-111,共3页Journal of Clinical Anesthesiology

基　　金：国家自然科学基金资助项目(30700783);高等学校博士学科点专项科研基金新教师项目(20070487117)

摘　　要：目的比较芬太尼、曲马多、布托啡诺和帕瑞昔布对全麻患者苏醒期躁动的治疗作用,探讨患者术后躁动治疗的合理化用药方案。方法全麻后出现苏醒期躁动的ASAⅠ或Ⅱ级成年患者120例,随机均分为四组:芬太尼组(F组)、曲马多组(T组)、布托啡诺组(B组)和帕瑞昔布组(P组),分别给予静脉注射芬太尼1μg/kg、曲马多1mg/kg、布托啡诺20μg/kg和帕瑞昔布40mg进行治疗。各组患者分别在用药前后进行VAS评分、Prince-Henry疼痛评分、Ramsay镇静评分和RSS躁动评分以评价药物治疗效果,记录患者可能的术后躁动诱发因素和麻醉后恢复室(PACU)停留时间。结果疼痛与导尿管刺激是引起苏醒期躁动的主要原因,T组躁动缓解率低于其他三组(P<0.05)。与用药前比较,四组患者用药后VAS评分和Prince-Henry疼痛评分均降低(P<0.05),而用药后T组VAS评分高于其他三组(P<0.05),用药后四组患者的Ramsay镇静评分较用药前均明显升高,其中B组患者高于其他三组(P<0.05)。B组患者在PACU停留时间长于其他三组(P<0.05)。结论帕瑞昔布是治疗苏醒期躁动较为安全有效的药物,芬太尼有可能会导致患者发生一过性呼吸抑制,布托啡诺可延长患者在PACU的停留时间,而曲马多对苏醒期躁动的治疗效果欠佳。Objective To compare the effects of fentanyl, tramadol, butorphanol and parecoxib on postoperative agitation in adult patients after general anesthesia and to figure out the rational treatment protocol for agitation. Methods One hundred and twenty ASAⅠ-Ⅱ adult patients suffered from postoperative agitation after general anesthesia were randomized into four groups and intravenously treated with fentanyl 1μg/kg （group F）, tramadol 1mg/kg （group T）, butorphanol 20μg/kg （group B） and parecoxib 40mg （group P） respectively. The VAS scale, Prince-Henry scale, Ramsay sedation scale and RSS agitation scale were assessed before and after treatment. The possible causes of postoperative agitation and duration of staying in postanesthesia care unit of each patient were recorded. Results Postoperative pain and urinal catheter stimulation were the main cause of agitation. Fentanyl, butorphanol and parecoxib could relieve agitation effectively. After treatment, VAS and Prince-Henry values decreased and Ramsay values increased in all groups. But VAS value in group T was still higher than other groups. Ramsay values in group B were higher than other groups. The duration of staying in postanesthesia care unit was longer than other groups. Conclusion Parecoxib is a safe and effective drug for the treatment of postoperative agitation. Administration of fentanyl may results in the temporary respiratory depression. Butorphanol could prolong the stay in postanesthesia care unit. And tramadol is not suitable for the treatment of agitation.

关 键 词：芬太尼 曲马多 布托啡诺 帕瑞昔布 躁动 

分 类 号：R614[医药卫生—麻醉学]