布托啡诺联合帕瑞昔布和丙泊酚在无痛人工流产手术中的应用  

Application of butorphanol combined with parecoxib and propofol in painless surgical abortion

作　　者：程艳 范英 黄则勇 李玉红 黄素琴 CHENG Yan;FAN Ying;HUANG Ze-yong;LI Yu-hong;HUANG Su-qin(Department of Anesthesiology,Shulan(Hangzhou)Hospital,Shulan International Medical College,Zhejiang Shuren University,Hangzhou ZHEJIANG 310004,China)

机构地区：[1]浙江树人学院树兰国际医学院附属树兰(杭州)医院麻醉科,浙江杭州310004

出　　处：《中国新药与临床杂志》2025年第1期53-57,共5页Chinese Journal of New Drugs and Clinical Remedies

基　　金：浙江省中医药科技计划项目(2023ZL593);杭州市医药卫生科技项目(B20220840,B20231958,B202330394)。

摘　　要：目的评价布托啡诺联合帕瑞昔布和丙泊酚的静脉镇静麻醉方案用于日间无痛人工流产的临床疗效。方法采用随机、双盲、前瞻性方法,选择择期无痛人工流产日间手术患者200例,随机分为高剂量组和低剂量组,分别静脉注射布托啡诺0.75 mg或布托啡诺0.5 mg和帕瑞昔布40 mg,5 min后静脉注射丙泊酚2 mg·kg^(-1)镇静麻醉。观察并记录意识消失和睁眼时间、丙泊酚剂量、呼吸抑制和血流动力学变化、术后宫缩痛和嗜睡以及其他并发症。结果高剂量组意识消失时间、睁眼时间均显著长于低剂量组(P<0.05)。高剂量组呼吸抑制发生率高于低剂量组(25%vs.13%,P=0.046),而2组体动发生率无显著差异(32%vs.38%,P=0.459)。2组术后均出现不同程度的宫缩痛,高剂量组的疼痛视觉模拟量表(VAS)评分高于低剂量组[2.0(1.0,2.0)vs.1.0(1.0,2.0),P<0.05]。高剂量组和低剂量组VAS评分为4~5分的患者分别有17例和7例,术后10 min、20 min镇静Ramsay评分>4分的患者分别有15例和5例、12例和2例,2组比较差异显著(P<0.05)。所有患者均未发生严重并发症。结论低剂量布托啡诺联合帕瑞昔布和丙泊酚在无痛人工流产术中麻醉起效时间和恢复时间均缩短,对术后宫缩痛效果更优,不良反应较少。AIM To evaluate the clinical efficacy of butorphanol combined with parecoxib and propofol intravenous sedation anesthesia for painless daytime abortion.METHODS A randomized,double-blind,prospective method was adopted.Two hundred patients undergoing elective daytime painless surgical abortion were randomly divided into high-dose group and low-dose group,and were injected intravenously with butorphanol 0.75 mg or butorphanol 0.5 mg+parecoxib 40 mg,respectively.Propofol 2 mg·kg^(-1) was administered intravenously 5 min after the injection of drugs.Time to loss of consciousness and eye opening,propofol dose,respiratory depression and hemodynamic changes,postoperative uterine contraction pain and drowsiness,and other complications were observed and recorded.RESULTS The time to loss of consciousness and time to eye opening were significantly longer in the high-dose group than in the low-dose group(P<0.05).The incidence of respiratory depression was higher in patients in the high-dose group than that in the low-dose group(25%vs.13%,P=0.046),whereas there was no significant difference in the incidence of somatic movements between the 2 groups(32%vs.38%,P=0.459).All patients experienced varying degrees of postoperative contraction pain.The pain visual analogue scale(VAS)scores were higher in the high-dose group than those in the low-dose group(2.0(1.0,2.0)vs.1.0(1.0,2.0),P<0.05).There were 17 and 7 patients with VAS scores of 4-5 in the high-dose group and low-dose group,respectively,and 15 and 5 patients and 12 and 2 patients with sedation Ramsay scores>4 at 10 min and 20 min postoperatively,respectively,with significant differences between the two groups(P<0.05).No serious complications occurred in all patients.CONCLUSION Low-dose butorphanol combined with parecoxib and propofol can shorten both the onset and offset time of anesthesia in painless abortion,have better effect on postoperative uterine contraction pain,and have fewer adverse reactions.

关 键 词：流产 人工 布托啡诺 帕瑞昔布 丙泊酚 

分 类 号：R971[医药卫生—药品]