不同剂量布托菲诺复合舒芬太尼对上腹部手术术后镇痛的影响
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摘要
目的探讨不同剂量布托菲诺复合舒芬太尼对上腹部手术术后镇痛的影响。方法选择2017年4—11月中国医科大学附属盛京医院择期行上腹部手术患者60例,美国麻醉医师协会分级Ⅰ或Ⅱ级。按照随机数字法分为3组,每组20例,术毕使用患者静脉自控镇痛,患者静脉自控镇痛配置方法三组分别为:S组(舒芬太尼2μg/kg)、SB1组(舒芬太尼2μg/kg+布托啡诺0. 05 mg/kg)、SB2组(舒芬太尼2μg/kg+布托啡诺0. 1 mg/kg)。记录三组患者术后2、6、12、24、48 h安静时的疼痛视觉模拟评分(VAS)评分、Ramsay镇静评分,记录患者按压镇痛泵次数、补救药物用量及例数。记录三组术后不良反应(恶心呕吐、嗜睡、呼吸抑制)的发生情况。结果术后2 h SB1组、SB2组镇痛效果起效均较S组快,SB1组和SB2组各时点VAS评分均显著低于S组,三组在组间、时点间比较差异均有统计学意义(P <0. 01),但组间和时点间交互作用比较差异无统计学意义(P> 0. 05)。S组Ramsay评分在术后呈先升高后降低的趋势。SB1组和SB2组Ramsay评分在24 h内较为稳定,在48 h开始降低,各时点均显著高于S组,SB2组Ramsay评分高于SB1组。三组Ramsay评分在组间、时点间和组间和时点间交互作用比较差异均有统计学意义(P <0. 01)。SB2组和SB1组按压镇痛泵的次数明显少于S组(P <0. 05),哌替啶使用总量显著低于S组(P <0. 05),三组补救镇痛率比较差异无统计学意义(P> 0. 05)。结论舒芬太尼2μg/kg+布托啡诺0. 05 mg/kg用于上腹部手术术后镇痛能显著降低患者术后疼痛。
Objective To observe the effect of different doses of butorphanol in combination with sufentanil on postoperative analgesia for upper abdominal surgery. Methods Sixty patients admitted to Shengjing Hospital from Apr. 2017 to Nov. 2017,with American Society of AnesthesiologistsⅠ orⅡ undergoing elective upper abdominal surgery under general anesthesia and using patient control intravenous analgesia after surgery were randomly divided into three groups according to random number ordering,20 patients each. The drugs used in patient control intravenous analgesia: in group S: sufentanil2 μg/kg; in group SB1: sufentanil 2 μg/kg + butorphanol 0. 05 mg/kg; in group SB2: sufentanil 2 μg/kg + butorphanol 0. 1 mg/kg. The visual analog scale (VAS) scores and Ramsay sedation scale scores were record at 2,6,12,24 and 48 h after surgery,also the adverse reactions such as nausea,vomiting and drowsiness,respiration depress after surgery were recorded. Results The onset time in either group SB1 or SB2 was faster than in group SB 2 h after operation,but VAS scores were lower in group SB1 and SB2 than in group S at different time intervals,the differences were statistically significant among the three groups and at different time points (P < 0. 01),but there were no significant differences in interaction between groups and time points (P > 0. 05). Ramsay scores increased first and then decreased in group S. The scores were stable within 24 h,but decreased at 48 h in both group SB1 and SB2,and were higher than group S at every time interval,moreover,the scores in group SB2 were higher those than in group SB1. The Ramsay score saw significant differences between groups,time intervals,and interaction of group and time interval (P < 0. 01). Pressing pump times in group SB1 and SB2 were significantly less than that of group S (P < 0. 05),the total usage of pethidine was significantly lower in group SB1 and SB2 than in group S (P < 0. 05),there was no significant difference in the rate of salvage analgesia among the three groups (P > 0. 05). Conclusion Sufentanil 2 μg/kg + butorphanol 0. 05 mg/kg for PCIA in the patients with upper abdominal surgery under general anesthesia can significantly alleviate the degree of pain and can be safely used in clinical.
Objective To observe the effect of different doses of butorphanol in combination with sufentanil on postoperative analgesia for upper abdominal surgery. Methods Sixty patients admitted to Shengjing Hospital from Apr. 2017 to Nov. 2017,with American Society of AnesthesiologistsⅠ orⅡ undergoing elective upper abdominal surgery under general anesthesia and using patient control intravenous analgesia after surgery were randomly divided into three groups according to random number ordering,20 patients each. The drugs used in patient control intravenous analgesia: in group S: sufentanil2 μg/kg; in group SB1: sufentanil 2 μg/kg + butorphanol 0. 05 mg/kg; in group SB2: sufentanil 2 μg/kg + butorphanol 0. 1 mg/kg. The visual analog scale (VAS) scores and Ramsay sedation scale scores were record at 2,6,12,24 and 48 h after surgery,also the adverse reactions such as nausea,vomiting and drowsiness,respiration depress after surgery were recorded. Results The onset time in either group SB1 or SB2 was faster than in group SB 2 h after operation,but VAS scores were lower in group SB1 and SB2 than in group S at different time intervals,the differences were statistically significant among the three groups and at different time points (P < 0. 01),but there were no significant differences in interaction between groups and time points (P > 0. 05). Ramsay scores increased first and then decreased in group S. The scores were stable within 24 h,but decreased at 48 h in both group SB1 and SB2,and were higher than group S at every time interval,moreover,the scores in group SB2 were higher those than in group SB1. The Ramsay score saw significant differences between groups,time intervals,and interaction of group and time interval (P < 0. 01). Pressing pump times in group SB1 and SB2 were significantly less than that of group S (P < 0. 05),the total usage of pethidine was significantly lower in group SB1 and SB2 than in group S (P < 0. 05),there was no significant difference in the rate of salvage analgesia among the three groups (P > 0. 05). Conclusion Sufentanil 2 μg/kg + butorphanol 0. 05 mg/kg for PCIA in the patients with upper abdominal surgery under general anesthesia can significantly alleviate the degree of pain and can be safely used in clinical.
引文
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[14]周伟,肖红霞,黄丽敏.地佐辛复合舒芬太尼用于老年人腹部手术术后镇痛的疗效观察[J].安徽预防医学杂志,2017,23(2):142-143.
[15]李洁,王贵桃,胡素清,等.两种镇痛方式对开胸术后患者舒适度及镇痛效果的分析[J].使用临床医药杂志,2016,20(14):66-68,75.
[16]Maciejewski D.Sufentanil in anaesthesiology and intensive therapy[J].Anestezjol Intens Ter,2012,44(1):35-41.
[17]L9tsch J.Pharmacokinetic-pharmacodynamic modeling of opioids[J].J Pain Symptom Manage,2005,29(Suppl 5):S90-103.
[18]Wilhelm W,Kreuer S.The place for short-acting opioids:special emphasis on remifentanil[J].Crit Care,2008,12(Suppl 3):5.
[19]Bailey PL,Streisand JB,East KA,et al.Differences in magnitude and duration of opioid-induced respiratory depression and analgesia with fentanyl and sufentanil[J].Anesth Analg,1990,70(1):8-15.
[20]De Haven Hudkins DL,Dolle RE.Peripherally restricted opioid agonist as novel analgesic agents[J].Curr Pharm Des,2004,10(7):743-757.
[21]叶飞,佘守章,邬子林.不同剂量布托啡诺静注对病人呼吸功能和镇静程度的影响[J].临床麻醉学杂志,2007,23(7):533-535.
[22]张兆平,孙国华,顾晓峰.布托啡诺在术后镇痛的应用[J].临床麻醉学杂志,2007,23(5):367-368.
[23]Dykstra LA.Butorphanol,levallorphan,nalbuphine and nalorphine as antagonists inthe squirrel monkey[J].J Pharmacol Exp Ther,1990,254(1):245-252.
[24]梁剑江,邓略初,梁锐枝.不同剂量布托啡诺复合芬太尼用于全身麻醉患者术后镇痛的临床研究[J].医学综述,2017,23(5):1018-1021.
[25]张旭彤.芬太尼与布托啡诺对镇痛效应联合作用的分子药理学机制[D].苏州:苏州大学,2016.
[26]赖爱华,李雪贞,温小平.布托啡诺联合舒芬太尼在头颈部肿瘤手术后镇静镇痛的应用[J].中国医学创新,2016,13(32):36-38.
[27]刘文兴,张永福,谭淑霞,等.布托啡诺与芬太尼联合用于妇科腹镜术后患者控静脉镇的效[J].广东医学,2008,29(7):1220-1221.
[28]段红,谭小红,杜艺,等.布托啡诺联合舒芬太尼用于腹部肿瘤患者术后自控静脉镇痛效果的观察[J].肿瘤预防与治疗,2011,23(4):317-319.
[2]Argoff CE.Recent management advances in acute postoperative pain[J].Pain Pract,2014,14(5):477-487.
[3]Rawal N.Current issues in postoperative pain management[J].Eur J Anaesthesiol,2016,33(3):160-171.
[4]Wu CL,Raja SN.Treatment of acute postoperative pain[J].Lancet,2011,377(9784):2215-2225.
[5]Macrae WA.Chronic post-surgical pain:10 years on[J].Br JAnaesth,2008,101(1):77-86.
[6]Kehlet H,Jensen TS,Woolf CJ.Persistent postsurgical pain:Risk factors and prevention[J].Lancet,2006,367(9522):1618-1625.
[7]Hurley RW,Murphy JD,Wu CL.Chapter 98,acute postoperative pain[M]//Miller RD,Cohen NH,Eriksson LI,et al.Miller's Anesthesia.8th ed.Philadelphia:Elsevier,2015:2974-2998.
[8]American Society of Anesthesiologists Task Force on Acute Pain Management.Practice guide lines for acute pain management in the perioperative setting:An updated report by the American Society of Anesthesiologists Task Force on acute pain management[J].Anesthesiology,2012,116:248-273.
[9]Imani F,Faiz HR,Sedaghat M,et al.Effects of adding ketamine to fentanyl plus acetaminophen on postoperative pain by patient controlled analgesia in abdominal surgery[J].Anesth Pain Med,2014,4(1):e12162.
[10]Chung JW,Lui JC.Postoperative pain management:Study of patients'level of pain and satisfaction with health care providers'responsiveness to their reports of pain[J].Nurs Health Sci,2003,5(1):13-21.
[11]Rozen WM,Tran TM,Ashton MW,et al.Refining the course of the thoracolumbar nerves:A new understanding of the innervation of the anterior abdominal wall[J].Clin Anat,2008,21:325-333.
[12]Darin Correll.Chronic postoperative pain:Recent findings in understanding and management[J].F1000 Res,2017,6:1054.
[13]潘海豹.围术期多模式镇痛治疗对上腹部手术病人术后应激反应及疼痛评分的影响[J].浙江创伤外科,2017,22(4):792-793.
[14]周伟,肖红霞,黄丽敏.地佐辛复合舒芬太尼用于老年人腹部手术术后镇痛的疗效观察[J].安徽预防医学杂志,2017,23(2):142-143.
[15]李洁,王贵桃,胡素清,等.两种镇痛方式对开胸术后患者舒适度及镇痛效果的分析[J].使用临床医药杂志,2016,20(14):66-68,75.
[16]Maciejewski D.Sufentanil in anaesthesiology and intensive therapy[J].Anestezjol Intens Ter,2012,44(1):35-41.
[17]L9tsch J.Pharmacokinetic-pharmacodynamic modeling of opioids[J].J Pain Symptom Manage,2005,29(Suppl 5):S90-103.
[18]Wilhelm W,Kreuer S.The place for short-acting opioids:special emphasis on remifentanil[J].Crit Care,2008,12(Suppl 3):5.
[19]Bailey PL,Streisand JB,East KA,et al.Differences in magnitude and duration of opioid-induced respiratory depression and analgesia with fentanyl and sufentanil[J].Anesth Analg,1990,70(1):8-15.
[20]De Haven Hudkins DL,Dolle RE.Peripherally restricted opioid agonist as novel analgesic agents[J].Curr Pharm Des,2004,10(7):743-757.
[21]叶飞,佘守章,邬子林.不同剂量布托啡诺静注对病人呼吸功能和镇静程度的影响[J].临床麻醉学杂志,2007,23(7):533-535.
[22]张兆平,孙国华,顾晓峰.布托啡诺在术后镇痛的应用[J].临床麻醉学杂志,2007,23(5):367-368.
[23]Dykstra LA.Butorphanol,levallorphan,nalbuphine and nalorphine as antagonists inthe squirrel monkey[J].J Pharmacol Exp Ther,1990,254(1):245-252.
[24]梁剑江,邓略初,梁锐枝.不同剂量布托啡诺复合芬太尼用于全身麻醉患者术后镇痛的临床研究[J].医学综述,2017,23(5):1018-1021.
[25]张旭彤.芬太尼与布托啡诺对镇痛效应联合作用的分子药理学机制[D].苏州:苏州大学,2016.
[26]赖爱华,李雪贞,温小平.布托啡诺联合舒芬太尼在头颈部肿瘤手术后镇静镇痛的应用[J].中国医学创新,2016,13(32):36-38.
[27]刘文兴,张永福,谭淑霞,等.布托啡诺与芬太尼联合用于妇科腹镜术后患者控静脉镇的效[J].广东医学,2008,29(7):1220-1221.
[28]段红,谭小红,杜艺,等.布托啡诺联合舒芬太尼用于腹部肿瘤患者术后自控静脉镇痛效果的观察[J].肿瘤预防与治疗,2011,23(4):317-319.