微创医学

目的比较布托啡诺与芬太尼对瑞芬太尼致腹腔镜术患者术后早期痛觉过敏(OIH)的防治作用。方法选取ASAⅠ～Ⅱ级、年龄18～55岁行择期腹腔镜手术患者90例,随机分为3组,各30例,均采用瑞芬太尼和丙泊酚全静脉麻醉,间断给予顺式阿曲库铵。A、B两组分别于停止输注瑞芬太尼前5 min静脉给予布托啡诺,A组为15μg/kg,B组为30μg/kg,C组对照给予芬太尼1.5μg/kg,记录各组苏醒时间、拔管时间、拔管时患者的血流动力学指标、拔管后30 min的VAS评分、Ramsay评分及拔管后苏醒期内患者呼吸抑制、术后烦躁及恶心呕吐等不良反应的情况。结果拔管时血流动力学指标3组比较差异无统计学意义(P>0.05);苏醒时间及拔管时间A组与B组差异无统计学意义(P>0.05),但均明显短于C组(P<0.05);苏醒拔管后30 min的VAS评分3组间比较差异无统计学意义(P>0.05);Ramsay评分A组清醒程度优于B、C组(P<0.05),B、C组间比较差异无统计学意义(P>0.05);呼吸抑制和恶心呕吐发生率C组高于A和B组,3组均无术中术后躁动的发生。结论对手术患者于手术结束前15 min静脉注射15μg/kg布托啡诺可安全有效地减轻瑞芬太尼麻醉后的痛觉过敏。

Objective To compare the effect of butorphanol and fentanyl on early remifentanil induced hyperalgesia after laparoscope． Methods 90 patients of ASA I － II，aged 18 to 55 years of age，planned for selective laparoscopic surgery were randomly divided into three groups，each of 30 cases，and all were given total intravenous anesthesia of remifentanil and propofol，and intermittent cisatracurium． Butorphanol was administrated intravenously with a dose of 15μg /kg for Group A， and 30 μg /kg for Group B，while fentanyl of 1． 5 μg /kg in Group C． Recovery time，time and hemodynamics of extubation，VAS 30 min after extubation， Ramsay score，and adverse effects，like respiratory depression，irritability，nausea and vomiting during analepsia after extubation were measured in three groups． Results There was no statistically significant difference in extubation hemodynamic parameters or VAS 30min after extubation in three groups． Both wake time and extubation time were apparently longer in Group C than in the other two． Ramsay scale in Group A was superior than that in Group B and Group C． Respiration depression，nausea and vomiting occurred more frequently in Group C than in the other two groups． No irritability was observed in all three groups． Conclusions Intravenous injection of 15μg /kg of butorphanol 15 min before the end of surgery can effectively reduce hyperalgesia after remifentanil．