酒石酸布托啡诺与舒芬太尼静脉自控镇痛对腹腔镜根治性肾切除术后早期康复的影响  

Effects of patient-controlled intravenous analgesia with butorphanol versus sufentanil on early postoperative rehabilitation following radical laparoscopic nephrectomy

作　　者：吕帅国 卢锡华 杨铁军 孙亚林 李鑫涛 缪长虹 Lyu Shuaiguo;Lu Xihua;Yang Tiejun;Sun Yalin;Li Xintao;Miao Changhong(Department of Anesthesiology and Perioperative Medicine,Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450008,China;Department of Urology,Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450008,China)

机构地区：[1]郑州大学附属肿瘤医院麻醉与围术期医学科,郑州450008 [2]郑州大学附属肿瘤医院泌尿外科,郑州450008

出　　处：《中华医学杂志》2020年第37期2947-2951,共5页National Medical Journal of China

摘　　要：目的探讨酒石酸布托啡诺与舒芬太尼静脉自控镇痛对腹腔镜根治性肾切除患者术后早期康复的影响。方法选取郑州大学附属肿瘤医院2018年9月至2020年2月择期行腹腔镜根治性肾切除术患者100例,随机数字表法分为2组(n=50):酒石酸布托啡诺静脉自控镇痛组(A组)和舒芬太尼静脉自控镇痛组(B组)。术毕行患者静脉自控镇痛(PICA),A组镇痛泵配方:酒石酸布托啡诺0.15 mg/kg、酮咯酸氨丁三醇180 mg,生理盐水稀释至100 ml。B组镇痛泵配方:舒芬太尼1.5μg/kg、酮咯酸氨丁三醇180 mg,生理盐水稀释至100 ml。记录两组患者在术后4、8、24、48 h(T1、T2、T3、T4)静息痛和活动痛的视觉模拟评分(VAS)评分。记录患者补救镇痛次数、术后48 h内镇痛泵有效按压次数、术后肛门恢复排气时间。在T3、T4时点采用40项恢复质量量表(QoR-40)评价患者术后恢复情况。记录不良反应发生情况。结果两组患者于T1、T2、T3和T4时静息和咳嗽状态下的VAS评分差异均无统计学意义(均P>0.05)。两组患者补救镇痛次数和术后48 h内镇痛泵有效按压次数差异均无统计学意义(均P>0.05)。A组患者术后肛门恢复排气时间为(32±6)h,早于B组的(40±5)h,差异有统计学意义(t=7.937 P<0.01)。A组患者在T3和T4时点QoR-40量表评分为(185.8±2.5)和(194.8±1.9)分,高于B组患者的(170.7±2.7)和(183.6±2.6)分,差异均有统计学意义(t=28.878、25.025,均P<0.01)。A组患者术后48 h内恶心、干呕/呕吐、呼吸抑制和瘙痒的发生率分别为10%、6%、2%、2%,均低于B组的32%、20%、14%、18%,差异均有统计学意义(χ2=7.294、4.322、4.891、5.983,均P<0.05)。结论酒石酸布托啡诺或舒芬太尼静脉自控镇痛均可为腹腔镜根治性肾切除术患者提供满意的术后镇痛效果,但酒石酸布托啡诺较舒芬太尼不良反应发生率更低,更有助于术后早期康复。Objective To investigate the effects of patient-controlled intravenous analgesia with butorphanol versus sufentanil on early postoperative rehabilitation following radical laparoscopic nephrectomy.Methods One hundred patients undergoing radical laparoscopic nephrectomy in Affiliated Cancer Hospital of Zhengzhou University from September 2018 to February 2020 were divided into two groups (n=50) using a random number table: butorphanol patient-controlled intravenous analgesia group (group A) and sufentanil patient-controlled intravenous analgesia group (group B). Patient-controlled intravenous analgesia (PCIA) was performed at the end of surgery. The formulation of group A was butorphanol (0.15 mg/kg) and ketorolac tromethamine (180 mg) using the physiological saline at a dilution of 100 ml. The formulation of group B was sufentanil (1.5 μg/kg) and ketorolac tromethamine (180 mg) using the physiological saline at a dilution of 100 ml. At the time points of 4, 8, 24, 48 h after operation (T1, T2, T3, T4), VAS scores at rest and cough were recorded. The incidence of remedial analgesia, the number of pressings during 48 h after the operation, the postoperative anal exhaust recovery time of the patients were recorded. Quality of recovery-40(QoR-40) scores were recorded at T3 and T4. Adverse reactions were recorded.Results There was no significant difference in VAS scores at rest and cough at T1, T2, T3 and T4 between two groups (all P>0.05). There was no significant difference in the incidence of remedial analgesia and the number of pressings during 48 h after the operation between two groups (all P>0.05). The postoperative anal exhaust recovery time of the patients in group A was (32±6) h, which was lower than that in group B with statistically significant difference [(40±5) h, t=7.937, P<0.01]. The QoR-40 total scores in group A were higher than those in group B at T3 and T4, which were (185.8±2.5) vs (170.7±2.7), (194.8±1.9) vs (183.6±2.6), and the differences were statistically significant (t=28.878, 25.025,

关 键 词：布托啡诺 镇痛 腹腔镜 肾切除术 康复 

分 类 号：R614[医药卫生—麻醉学] R737.11[医药卫生—外科学]