不同剂量布托啡诺在髋关节置换术停用瑞芬太尼后的镇痛效果观察  

Analgesic effect of different doses of butorphanol after discontinuation of remifentanil in hip replacement

作　　者：邓晓东 朱敏敏[2] 殷政[2] 商允 DENG Xiao-dong;ZHU Min-min;YIN Zheng(Department of Anesthesia,Wuxi Rehabilitation Hospital,Wuxi 214043,China)

机构地区：[1]江苏省无锡市康复医院麻醉科,214043 [2]江苏省无锡市第二人民医院麻醉科,214000

出　　处：《中国实用医药》2019年第35期92-94,共3页China Practical Medicine

摘　　要：目的观察髋关节置换术患者停用瑞芬太尼后不同剂量布托啡诺维持镇痛的效果。方法 45例髋关节置换术行气管插管全身麻醉(全麻)患者,随机分为Ⅰ、Ⅱ、Ⅲ组,每组15例。三组术中均采用瑞芬太尼复合丙泊酚、七氟烷维持麻醉,手术结束前20 min,Ⅰ组应用布托啡诺10μg/kg、Ⅱ组应用布托啡诺15μg/kg、Ⅲ组应用布托啡诺20μg/kg。比较三组患者术后不同时间点[术后10 min(T1)、30 min(T2)、60 min(T3)、90 min(T4)、120 min(T5)]数字疼痛评分法(NRS)评分、Ramsay镇静评分及苏醒时间、拔管时间、离开麻醉后监测治疗室(PACU)时间及不良反应发生情况。结果 T1、T2、T3时,Ⅰ组患者的NRS评分明显高于Ⅱ组、Ⅲ组,Ⅲ组患者的Ramsay镇静评分明显高于Ⅰ组、Ⅱ组,差异均具有统计学意义(P<0.05);T4、T5时,三组的NRS评分和Ramsay镇静评分比较差异均无统计学意义(P>0.05)。Ⅲ组患者的苏醒时间、拔管时间及离开PACU时间分别为(16.9±4.8)、(23.1±5.7)、(65.0±10.7)min,均明显长于Ⅰ组的(12.9±4.5)、(18.7±4.7)、(54.3±11.2)min和Ⅱ组(13.2±4.1)、(18.9±5.1)、(55.7±12.7)min,差异均具有统计学意义(P<0.05);三组患者的不良反应发生率比较差异均无统计学意义(P>0.05)。结论术毕前给予布托啡诺能有效抑制瑞芬太尼停药后的痛觉恢复, 15μg/kg剂量具有对患者全麻后苏醒质量影响少的优势。Objective To observe the effect of different doses of butorphanol after discontinuation of remifentanil in hip replacement. Methods A total of 45 cases of general anesthesia with tracheal intubation in hip replacement were randomly divided into group Ⅰ, group Ⅱ and group Ⅲ, with 15 cases in each group. Three groups received remifentanil combined with propofol and sevoflurane for maintenance anesthesia. At 20 min before the end of the operation, group Ⅰ was treated with butorphin 10 μg/kg, group Ⅱ was treated with butorphin 15 μg/kg, group Ⅲ were treated with butorphinol at 20 μg/kg. The numerical rating scale(NRS) score, Ramsay sedation score at different time points [10 min after operation(T1), 30 min after operation(T2), 60 min after operation(T3), 90 min after operation(T4), 120 min after operation(T5)], wake-up time, extubation time, postanesthesia care unit(PACU) time and occurrence of adverse reactions was compared among three groups. Results At T1, T2 and T3, the NRS score in group Ⅰ was obviously higher than those in group Ⅱ and group Ⅲ, and the Ramsay sedation score in group Ⅲ was obviously higher than those in group Ⅰ and group Ⅱ. Their difference was statistically significant(P<0.05). At T4 and T5, there was no statistically significant difference in NRS score and Ramsay sedation score among three groups(P>0.05). The wake-up time, extubation time and PACU time were(16.9±4.8),(23.1±5.7) and(65.0±10.7) min in group Ⅲ, which was obviously longer than(12.9±4.5),(18.7±4.7),(54.3±11.2) min in group Ⅰ and(13.2±4.1),(18.9±5.1),(55.7±12.7) min in group Ⅱ. Their difference was statistically significant(P<0.05). There was no statistically significant difference in incidence of adverse reactions among the three groups(P>0.05). Conclusion Butorphanol before the end of operation can effectively inhibit the recovery of pain after discontinuation of remifentanil. 15 μg/kg dose has less influence on the quality of recovery after general anesthesia.

关 键 词：布托啡诺 瑞芬太尼 维持麻醉 髋关节置换术 

分 类 号：R61[医药卫生—外科学]