布托啡诺减轻烧伤切痂植皮术中瑞芬太尼所致痛觉过敏的临床研究  

Clinical research of butorphanol in relieving hyperalgesia caused by remifentanil during escharectomy and skin grafting

作　　者：梁娟 林鹏焘[2] 蔡东妙[1] LIANG Juan;LIN Pengtao;CAI Dongmiao(Department of Anesthesiology,the First Affiliated Hospital of Xiamen University,Fujian,Xiamen 361000,China;Department of Anesthesiology,Fujian Medical University Union Hospital,Fujian,Fuzhou 350000,China)

机构地区：[1]厦门大学附属第一医院麻醉科,福建厦门361000 [2]福建医科大学附属协和医院麻醉科,福建福州350000

出　　处：《中国医药科学》2022年第13期167-171,共5页China Medicine And Pharmacy

摘　　要：目的观察布托啡诺在烧伤切痂植皮术中对瑞芬太尼所致痛觉过敏的影响。方法选取2018年9月至2019年2月福建医科大学附属协和医院烧伤科行切痂植皮手术的患者60例,采用随机数字表法分为B组(在切皮前给予布托啡诺20μg/kg)、C组(在切皮前给予与布托啡诺等容量的生理盐水),每组各30例。采用Von Frey纤毛机械刺激针测定患者术前30 min和术后1 h右前臂内侧及取皮部位附近皮肤的触痛阈值。记录患者入室后(T_(1))、诱导后(T_(2))、切皮时(T_(3))、包扎时(T_(4))、拔管后(T_(5))的心率、平均动脉压。记录患者术中瑞芬太尼用量及术后自主呼吸恢复时间、拔管时间。记录患者拔管后5 min(t_(1))、30 min(t_(2))、1 h(t_(3))、6 h(t_(4))、12 h(t_(5))、24 h(t_(6))的VAS评分和Ramsay镇静评分。记录患者术后使用止痛药次数及不良反应。结果术前两组右前臂内侧及取皮部位附近触痛阈值比较,差异无统计学意义(P>0.05);术后B组右前臂内侧触痛阈值大于C组,差异有统计学意义(P<0.05);两组取皮部位附近触痛阈值比较,差异无统计学意义(P>0.05);两组患者术中心率、平均动脉压、瑞芬太尼用量及术后自主呼吸恢复时间、拔管时间比较,差异无统计学意义(P>0.05)。B组拔管后各时间点VAS评分均低于C组,B组t_(1)~t_(3)的Ramsay评分高于C组,差异有统计学意义(P<0.05),而t_(4)~t_(6)的Ramsay评分与C组比较,差异无统计学意义(P>0.05);B组术后使用镇痛药次数、恶心呕吐发生率低于C组,差异有统计学意义(P<0.05)。两组患者术后眩晕、嗜睡、心动过缓不良事件发生率比较,差异无统计学意义(P>0.05)。结论布托啡诺可减轻烧伤切痂植皮术中瑞芬太尼诱导的痛觉过敏,减少术后止痛药的用量。Objective To observe the impact of butorphanol in relieving hyperalgesia caused by remifentanil during burn escharotomy and skin grafting.Methods A total of 60 patients who underwent burn escharotomy and skin grafting admitted to the department of burn in the Fujian Medical University Union Hospital from September 2018 to February 2019 were selected.They were divided into group B(n=30,butorphanol of 20μg/kg was given before burn escharotomy and skin grafting)and group C(n=30,normal saline of the same volume as butorphanol was given before burn escharotomy and skin grafting)according to the random number table method.Von Frey ciliature mechanical stimulation needle was used to measure the threshold of haphalgesia of the skin on the inner side of the right forearm and near the skin removal site at 30 min before the operation and 1 h after the operation.The heart rates and mean arterial pressures of patients after admission(T_(1)),induction(T_(2)),skin incision(T_(3)),bandaging(T_(4))and extubation(T_(5)) were recorded.The dosage of remifentanil for patients during operation,the recovery time of spontaneous respiration and extubation time after the operation were recorded.The VAS scores and Ramsay sedation scores of patients at 5 min(t_(1)),30 min(t_(2)),1 h(t_(3)),6 h(t_(4)),12 h(t_(5))and 24 h(t_(6))after extubation were recorded.The times of using painkillers and adverse reactions of patients after the operation were recorded.Results Before the operation,there was no statistically significant difference in the threshold of haphalgesia between two the groups before the operation in the inner side of the right forearm and near the skin removal site(P>0.05).After the operation,the threshold of haphalgesia in the inner side of the right forearm in group B was higher than that in group C,with statistically significant difference(P<0.05).However,there was no statistically significant difference between the two groups near the skin removal site(P>0.05).There were no statistically significant differences between the two

关 键 词：布托啡诺 瑞芬太尼 痛觉过敏 切痂植皮术 

分 类 号：R614[医药卫生—麻醉学]