静脉患者自控镇痛前注射布托啡诺对腹腔镜结肠癌根治术患者全身麻醉苏醒质量的影响  

Effect of butorphanol injected before intravenous patient-cotrolled analgesia on quality of waking up in patients undergoing laparoscopic radical resection of colon cancer

作　　者：刘丽 许勇 陈权 尚游 LIU Li;XU Yong;CHEN Quan(Department of Anesthesiology,First Affiliated Hospital,Jinzhou Medical University,Jinzhou 121004,CHINA)

机构地区：[1]锦州医科大学附属第一医院麻醉科,辽宁121004

出　　处：《江苏医药》2021年第11期1164-1168,共5页Jiangsu Medical Journal

基　　金：辽宁省教育厅科学技术研究项目(JZTJCZR2020050)。

摘　　要：目的观察静脉患者自控镇痛(PCA)前注射布托啡诺对腹腔镜结肠癌根治术患者全身麻醉(全麻)苏醒质量的影响。方法 80例行腹腔镜结肠癌根治术患者随机均分为布托啡诺(B组)和舒芬太尼(C组),分别于手术结束前30 min静脉注射布托啡诺20μg/kg和舒芬太尼0.1μg/kg。手术结束前10 min停用麻醉药并行静脉PCA。记录手术结束给药前(T0)、气管导管拔除前(T1)、拔管即刻(T2)、拔管后5 min(T3)、拔管后10 min(T4)和离开麻醉复苏室时(T5)的HR、MAP和SpO;记录自主呼吸恢复时间、睁眼时间、拔管时间和复苏室停留时间T2~T5时的数字评价量表(NRS)疼痛评分、Ramsay镇静评分和苏醒期躁动评分。采用ELISA法和葡萄糖氧化酶法分别检测T0、T3和T5时皮质醇(Cor)和FBG浓度。观察全麻苏醒期不良反应发生情况。结果 C组T1、T2时HR、MAP高于T0,且高于B组(P<0.05);C组T3时SpO;低于B组(P<0.05)。与C组相比,B组自主呼吸恢复时间、睁眼时间、拔除气管导管时间、复苏室停留时间均缩短(P<0.05)。两组不同时间点NRS疼痛评分差异均无统计学意义(P>0.05);B组T2~T4时的Ramsay镇静评分和苏醒期躁动评分低于C组(P<0.05)。C组T5时Cor浓度高于T0时,且高于B组(P<0.05)。C组不良反应发生率高于B组(P<0.05)。结论静脉PCA前静脉注射布托啡诺能提高术后镇痛效果,减轻应激反应,维持循环稳定,改善苏醒质量,降低不良反应。Objective To observe the effect of butorphanol injected before intravenous patient-cotrolled analgesia(PCA) on the quality of waking up in the patients undergoing laparoscopic radical resection of colon cancer.Methods A total of 80 patients undergoing selective laparoscopic radical resection of colon cancer were equally randomized into two groups.At 30 minutes before the end of surgery, butorphanol 20 μg/kg was intravenously injected in group B and sufentanil 0.1 μg/kg in group C.At 10 minutes before the end of surgery, anesthetic drugs were stopped and intravenous PCA was started.The HR,MAP and SpO;were recorded before administration(T0),before extubation(T1),immediately after extubation(T2),at 5 minutes after extubation(T3),at 10 minutes after extubation(T4) and left postanesthesia care unit(T5).The spontaneous breathing recovery time, the time of open eyes, extubation time and postan esthesia care unit stay timewere recorded.Numeric rating scales(NRS) pain score, Ramsay sedation score and agitation score at T2-T5 were recorded.The blood levels of cortisol and fasting blood glucose at T0,T3 and T5 were detected by ELISA and glucose oxidase methods, respectively.The incidence of adverse responses was observed during the recovery period of general anaesthesia.Results The HR and MAP at T1 and T2 in group C were higher than those at T0 and in group B(P<0.05).The SpO;at T3 in group C was lower than that in group B(P<0.05).Compared with group C,the spontaneous breathing recovery time, the time of open eyes, extubation time and postanesthesia care unit stay were shorter in group B(P<0.05).There was no statistical difference in the NRS pain score at different time points between groups of B and C(P>0.05).Ramsay sedation score and agitation score at T2-T4 in group B were lower than those in group C(P<0.05).Blood level of cortisol at T5 in group C was higher than that at T0 and in group B(P<0.05).The incidence of adverse responses in group C was higher than that in group B(P<0.05).Conclusion Intravenous injection of bu

关 键 词：布托啡诺 舒芬太尼 镇痛 苏醒质量 

分 类 号：R614[医药卫生—麻醉学]