布托啡诺对ICU重症急性胰腺炎患者的镇痛效果  

An analysis of analgesic effect of butorphanol on patients with severe acute pancreatitis in intensive care unit

作　　者：郑文涛[1] 孙振棣[1] 王爱芹[1] 

机构地区：[1]滨州市人民医院重症医学科,山东滨州256600

出　　处：《中国中西医结合急救杂志》2016年第6期593-596,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的 比较布托啡诺与芬太尼用于重症加强治疗病房（ICU）重症急性胰腺炎（SAP）患者的镇痛效果及不良反应.方法 选择山东省滨州市人民医院ICU 2014年8月至2015年11月收治的SAP患者42例,按随机数字法分为布托啡诺组和芬太尼组,每组21例.布托啡诺组先静脉注入布托啡诺10 μg/kg负荷剂量,然后12 mg加0.9％生理盐水至50 mL微量泵持续静脉输注;芬太尼组先静脉注入枸橼酸芬太尼1g/kg负荷剂量,然后用0.1 mg加生理盐水至50 mL微量泵持续静脉输注;两组均根据患者疼痛程度在用药范围内调节输注速度.用视觉模拟疼痛评分法（VAS）评估两组的镇痛效果,记录两组患者用药前及用药后1、2、4 h VAS评分和用药后1h心率（HR）、平均动脉压（MAP）、氧合指数;并观察两组用药后呕吐发生率、胃肠蠕动恢复时间、ICU住院时间及不良反应发生情况.结果 随着用药时间的延长,布托啡诺组和芬太尼组用药后1、2、4hVAS评分均较用药前明显降低（分：布托啡诺组为2.43±0.73、2.55±0.89、2.49±0.86比8.46±1.19;芬太尼组为2.61±0.62、2.48±0.93、2.45±0.75比8.22±0.81,均P＜0.05）;但两组用药后各时间点VAS评分比较差异均无统计学意义（均P＞0.05）.布托啡诺组和芬太尼组用药后1 h MAP、HR均较用药前明显降低[MAP（mmHg,1 mmHg =0.133 kPa）：布托啡诺组为72.21±9.39比82.93±10.38,芬太尼组为76.32±10.45比86.52±11.39,HR（次/min）：布托啡诺组为82.32±13.35比96.13±8.62,芬太尼组为83.21±14.23比92.1±7.55],氧合指数较用药前有所升高,但差异无统计学意义（mmHg：布托啡诺组为180.23±24.88比174.23±25.56,芬太尼组为174.56±22.38比168.32±20.66）;两组患者用药后HR、MAP、氧合指数比较差异均无统计学意义（均P＞0.05）.布托啡诺组胃肠蠕动恢复时间和ICU住院时间均较芬太尼组明显缩短[胃肠蠕动恢复时间（d）：2.32±0.85比4.76±1.23,ICU住院时间�Objective To compare the analgesic efficacy and adverse reaction between butorphanol and fentanyl on patients with severe acute pancreatitis （SAP） in intensive care unit （ICU）. Methods Forty-two patients with SAP admitted to Intensive Care Unit （ICU） in Binzhou People＇s Hospital from August 2014 to November 2015 were enrolled, and they were divided into butorphanol group and fentanyl group by random number table, each group 21 cases. The patients in the butorphanol group were given firstly by intravenous injection （IV） of a loading dose 10 μg/kg butorphanol, and then 12 mg butorphanol in 50 mL normal saline was continuously IV infused by a micro pump; the patients in the fentanyl group were given firstly a loading dose 1μg/kg fentanyl by intravenous injection, and then 0.1 mg fentanyl in 50 mL nonnal saline continuously infused intravenously by a micro pump. The infusion speed was adjnsted in the two groups according to the patients＇ pain extent within the dose scope of lbe drug. The visual analogue scale （VAS） was used to evaluate the analgesic effects. Before treatment and after treatment for 1, 2 and 4 hours, the scores of VAS were recorded, before and after treatment for 1 hour, the heart rate （HR）, the mean arterial pressure （MAP） and oxygenation index were recorded; after treatment, the incidence of vomiting, recovery time of gastrointestinal motility, the ICU length of stay and adverse reaction were observed in the two groups. Results With the extension of medication time, in both butorphanol and fentanyl groups the scores of VAS at every time point were obviously lower than those before treatment （bulorphanol group 2.43±0.73, 2.55±0.89, 2.49±0.86 vs. 8.46±1.19; fentanyl group： 2.61±0.62, 2.48±0.93, 2.45±0.75 vs. 8.22±0.81, all P 〈 0.05）. The difference in scores of VAS was not significant between butorphanol group and fentanyl group at every time point after treatment. The HR and MAP after 1 hour of the analgesic drug administration in two groups were mark

关 键 词：重症加强治疗病房 胰腺炎 急性 重症 布托啡诺 芬太尼 镇痛 

分 类 号：R657.51[医药卫生—外科学]