Objective To investigate the safety and effectiveness of butorphanol and pethidine in the prevention of shivering during appendectomy.Methods A total of 120 patients undergoing elective appendectomy with subarachnoid-epidural anesthesia(ASA grade Ⅰ or Ⅱ) from October 2014 to October 2015 in Tong Ren Hospital,Shanghai Jiao Tong University School of Medicine were randomly divided into butorphanol group,pethidine group and control group,each group of 40 cases.After anesthesia procedure,butorphanol group,pethidine group and control group were treated with butorphanol 1 mg(diluted to 5 ml with 0.9％ sodium chloride solution),pethidine 15 mg(diluted to 5 ml with 0.9％ sodium chloride solution) and 0.9％ sodium chloride solution 5 ml,respectively,with intravenous injection in 1 min.Mean arterial pressure(MAP),pulse oxygen saturation(SpO2)and heart rate were recorded before drug administration and at 5,15,30 min after drug administration.Occurrences of shivering and adveme reactions were observed.Results MAP and heart rate in pethidine group at 5 min after treatment were significantly higher than those before treatment and those in control group and butorphanol group at the same time point [(113 ± 13) mmHg vs (89 ± 12),(89 ± 12),(90 ± 13) mmHg;(106 ±9) times/min vs (77 ± 6),(76 ± 5),(77 ± 5) times/min] (P ＜ 0.05);differences of MAP,SpO2 and heart rate between butorphanol group and control group were not significant (P ＞ 0.05).Incidences of shivering in butorphanol group and pethidine group at 5,10 min after treatment were significantly lower than those in control group[5.0％ (2/40),12.5％ (5/40) vs 40.0％ (16/40);0.0％ (0/40),0.0％ (0/40) vs 22.5％ (9/40)](P ＜ 0.05);the difference of shivering incidence between butorphanol group and control group was not significant (P ＞ 0.05).The incidence of nausea and vomiting in pethidine group was significantly higher than those in butorphanol group and control group [35.0％ (14/40) vs 0.0％ (0/40),5.0％ (2/40)] (P ＜ 0.05);the incidence of sleepiness in butorphanol group was significantly higher than those in pethidine group and control group[82.5％ (33/40) vs 22.5％ (9/40),0.0％ (0/40)] (P ＜0.05).Conclusion Both butorphanol and pethidine can effectively prevent the occurrence of shivering during appendectomy;butorphanol is associated with a lower incidence of adverse reactions and has no significant effect on the hemodynamics in patients.%目的 比较布托啡诺和哌替啶预防阑尾切除术中寒战的有效性和安全性.方法 选择2014年10月至2015年10月上海交通大学医学院附属上海市同仁医院收治的120例急性阑尾炎行阑尾切除术患者作为研究对象,美国麻醉医师协会分级Ⅰ～Ⅱ级,麻醉方式均为蛛网膜下腔-硬膜外麻醉.将120例患者按照随机数字表法分为布托啡诺组、哌替啶组和对照组,各40例.麻醉操作完成后,布托啡诺组、哌替啶组和对照组分别静脉注射布托啡诺1 mg、哌替啶15 mg和0.9％氯化钠注射液5 ml,药物静脉注射前用0.9％氯化钠注射液将布托啡诺、哌替啶稀释至5ml,注射时间1 min.比较3组患者用药前及用药后5、15、30 min的平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、心率和用药后5、15、30 main的寒战发生情况以及用药后不良反应发生情况.结果 用药后5 min,哌替啶组MAP、心率均明显高于用药前和对照组及布托啡诺组[(113±13) mmHg(1 mmHg=0.133 kPa)比(89±12)、(89±12)、(90±13) mmHg,(106±9)次/min比(77±6)、(76±5)、(77±5)次/min],差异有统计学意义(P＜0.05);布托啡诺组和对照组麻醉用药后不同时点MAP、SpO2、心率比较差异无统计学意义(P＞0.05).用药后5、15 min,布托啡诺组、哌替啶组寒战发生率均明显低于对照组[5.0％(2/40)、12.5％ (5/40)比40.0％ (16/40),0.0％ (0/40)、0.0％ (0/40)比22.5％ (9/40)],差异有统计学意义(P＜0.05);布托啡诺组、哌替啶组不同时点寒战发生率比较差异无统计学意义(P＞0.05).哌替啶组恶心呕吐发生率高于布托啡诺组和对照组[35.0％(14/40)比0.0％ (0/40)、5.0％ (2/40)],布托啡诺组嗜睡发生率高于哌替啶组和对照组[82.5％ (33/40)比22.5％ (9/40)、0.0％ (0/40)],差异均有统计学意义(均P＜0.05).结论 布托啡诺、哌替啶均能够有效预防阑尾切除术中寒战的发生,但布托啡诺的不良反应发生率更低,且对患者血流动力学无明显影响.
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