布托啡诺和地佐辛复合其他镇痛药物用于腹部手术后镇痛的观察

摘要

Objective To compare the analgesic effect and adverse event of butorphanol and dezocine which are combined with sufentanil and flurbiprofen axetil in PCIA,to screen out a relatively good analgesic.Methods 110 laparotomy cases from hepato-pancreato-biliary (HPB) department and 160 laparoscopy cases from general surgery(GS) department of xinqiao hospital of third medical university were included in our study.All patients were randomly divided into two groups according to the random number table method,namely the butorphanol group and dezocine group.Butorphanol 0.04 mg/kg,sufentanil 2.8 μg/kg,flurbiprofen axetil 3 mg/kg and granisetron 6 mg were used in HPB butorphanol group.Dezocine 0.2 mg/kg,sufentanil 2.8 μg/kg,flurbiprofen axetil 3 mg/kg and granisetron 6 mg were used in HPB dezocine group.Butorphanol 0.04 mg/kg sufentanil 2.5 μg/kg,flurbiprofen axetil 3 mg/kg and granisetron 6 mg was used in GS butorphanol group.Dezocine 0.2 mg/kg,sufentanil 2.5 μg/kg,flurbiprofen axetil 3 mg/kg and granisetron 6 mg was used in GS dezocine group.The mean arterial pressure(MAP),heart rate(HR),facial expressions of pain score,sedation score,PONV score,NRS score and respiratory depression were observed in postoperative 0 hour,6 hours,24 hours,48 hours.Results For both two departments,the numbers of patients with NRS score and facial expressions of pain scores greater than 3 in dezocine group were more than those in butorphanol group,the differences were significant(P ＜ 0.05).There was no statistically significant difference in numbers of patients with NRS score and facial expressions scale of 1 to 3 (P ＞ 0.05).while the number of cases with sedation score ranged from 1 to 3 in dezocine group was less than that in both HPB and GS butorphanol group(P ＜ 0.05).There was no statistically significant difference in PONV score and itching score which was or less than 3 or more than 3 (P ＞ 0.05).Conclusion For postoperative analgesia in PCIA,butorphanol has better analgesic effect than the same dose of dezocine,and stronger sedation effect than dezocine.%目的 通过比较布托啡诺和地佐辛联合其他镇痛药用于患者静脉自控镇痛(PCIA)的镇痛效果和不良反应,筛选相对较好的镇痛方案.方法 选择第三军医大学新桥医院肝胆科择期全麻下行开放手术的患者110例和普外科行腹腔镜手术的患者160例,两科室患者均采用随机数字表法分为2组,即布托啡诺组和地佐辛组.肝胆科患者布托啡诺组采用布托啡诺0.04 mg/kg+舒芬太尼2.8 μg/kg+氟比洛芬酯3 mg/kg+格拉司琼6 mg的镇痛配方,地佐辛组采用与布托啡诺等效剂量用量,即地佐辛0.2 mg/kg+舒芬太尼2.8 μg/kg+氟比洛芬酯3 mg/kg+格拉司琼6 mg的配方,普外科患者布托啡诺组采用布托啡诺0.04 mg/kg+舒芬太尼2.5 μg/kg+氟比洛芬酯3 mg/kg+格拉司琼6 mg的镇痛配方,地佐辛组采用与布托啡诺等效剂量用量,即地佐辛0.2 mg/kg+舒芬太尼2.5 μg/kg+氟比洛芬酯3 mg/kg+格拉司琼6 mg的配方.分别于术后0h、6h、24h、48 h观察并统计患者的平均动脉压、心率、疼痛NRS评分、面部表情评分、镇静状态评分、恶心NRS评分、呕吐NRS评分、瘙痒NRS评分、呼吸抑制等指标.结果 两个科室地佐辛组疼痛NRS评分和面部表情评分大于3分的患者均多于布托啡诺组,差异有统计学意义(P＜0.05);疼痛NRS评分和面部表情评分为1～3分的患者,差异无统计学意义(P＞0.05),镇静评分为1～3分患者个数两个科室布托啡诺组均多于地佐辛组,差异具有统计学意义(P＜0.05);恶心、呕吐、瘙痒小于等于3分和大于3分患者数,差别均无统计学意义(P＞0.05).结论 腹部手术患者使用等效剂量的布托啡诺镇痛和地佐辛术后镇痛,布托啡诺镇痛效果好于地佐辛,镇静强度布托啡诺强于地佐辛.