布托啡诺对肾移植患者全麻苏醒期的影响
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摘要
目的探讨酒石酸布托啡诺注射液对肾移植术患者全麻苏醒期的影响。方法选择2017年5月—2017年12月在天津市第一中心医院行同种异体肾移植术患者60例作为研究对象,将所有患者随机分为对照组和治疗组,每组各30例。两组患者全麻诱导和维持用药方式相同,治疗组在开始缝皮前静脉注射酒石酸布托啡诺注射液0.02 mg/kg,对照组给予相同容量生理盐水。观察并记录术后拔管前5 min(T_1)、拔管即刻(T_2)、拔管后5 min(T_3)、拔管后10 min(T_4)的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO_2)。并于拔管术后2、4、8、12h时记录患者VAS评分、Ramsay评分。观察术后不良反应情况、术后镇痛泵按压情况。结果与T_1时间点比较,对照组在T_2～T_4时间点MAP、HR水平显著升高,T_2～T_3时间点SpO_2水平下降,同组比较差异具有统计学意义(P<0.05);与对照组同期比较,治疗组MAP在T_3～T_4、HR在T_2～T_3均显著降低,两组比较差异具有统计学意义(P<0.05)。与对照组同期比较,治疗组患者术后2、4、8 h VAS评分、Ramsay评分均显著降低,两组比较差异具有统计学意义(P<0.05)。与对照组比较,治疗组术后发生恶心呕吐、躁动的例数显著降低,两组比较差异具有统计学意义(P<0.05)。与对照组比较,治疗组首次按压镇痛泵时间明显增加,术后24h内有效按压次数显著减少,两组比较差异具有统计学意义(P<0.05)。结论在缝皮前静注酒石酸布托啡诺注射液用于肾移植苏醒期有助于术后镇痛和镇静,降低苏醒期恶心、呕吐的发生率,可安全应用于肾移植患者的麻醉。
Objective To investigate the effect of Butorphanol Tartrate Injection on recovery period of general anesthesia in renal transplantation patients. Methods Patients(60 cases) undergoing allogeneic kidney transplantation in Tianjin First Center Hospital from May 2017 to December 2017 were randomly divided into control and treatment groups, and each group had 30 cases. Patients in two groups were received general anesthesia induction and maintenance in the same way. Patients in the treatment group were iv administered with Butorphanol Tartrate Injection 0.02 mg/kg before suture, while patients in the control group were received the same volume of saline. The mean MAP, HR, and SpO_2 were observed and recorded at the time of 5 minutes before extubation(T1),extubation(T2), 5 min after extubation(T3), and 10 min after extubation(T4). And the VAS scores and Ramsay scores were recorded at 2, 4, 8, and 12 h after extubation. Postoperative adverse reactions and pressing of analgesic pump were observed. Results Compared with T_1 time point, the levels of MAP and HR in the control group were significantly increased at T_2 — T_4 time point, and SpO_2 were decreased at T_2 — T_3 time point, and there were differences in the same group(P < 0.05). Compared with the control group in the same period, MAP at T_3 — T_4 and HR at T_2 — T_3 time point in the treatment group were significantly decreased, and there were differences between two groups(P < 0.05). Compared with the control group in the same period, VAS scores and Ramsay scores at 2, 4, and 8 h after surgery in the treatment group were significantly decreased, there were differences between two groups(P < 0.05). Compared with the control group, the numbers of nausea, vomiting, and restlessness in the treatment group were significantly decreased, and there were differences between two groups(P < 0.05). Compared with the control group, the time of first pressing analgesic pump was significantly increased, but the number of effective pressing was significantly reduced within 24 h after operation in the treatment group, and there were differences between two groups(P < 0.05). Conclusion Intravenous injection of Butorphanol Tartrate Injection before suture is helpful for postoperative analgesia and sedation after kidney transplantation, reduce the incidence of nausea and vomiting, can be safely used in anesthesia of renal transplantation patients.
Objective To investigate the effect of Butorphanol Tartrate Injection on recovery period of general anesthesia in renal transplantation patients. Methods Patients(60 cases) undergoing allogeneic kidney transplantation in Tianjin First Center Hospital from May 2017 to December 2017 were randomly divided into control and treatment groups, and each group had 30 cases. Patients in two groups were received general anesthesia induction and maintenance in the same way. Patients in the treatment group were iv administered with Butorphanol Tartrate Injection 0.02 mg/kg before suture, while patients in the control group were received the same volume of saline. The mean MAP, HR, and SpO_2 were observed and recorded at the time of 5 minutes before extubation(T1),extubation(T2), 5 min after extubation(T3), and 10 min after extubation(T4). And the VAS scores and Ramsay scores were recorded at 2, 4, 8, and 12 h after extubation. Postoperative adverse reactions and pressing of analgesic pump were observed. Results Compared with T_1 time point, the levels of MAP and HR in the control group were significantly increased at T_2 — T_4 time point, and SpO_2 were decreased at T_2 — T_3 time point, and there were differences in the same group(P < 0.05). Compared with the control group in the same period, MAP at T_3 — T_4 and HR at T_2 — T_3 time point in the treatment group were significantly decreased, and there were differences between two groups(P < 0.05). Compared with the control group in the same period, VAS scores and Ramsay scores at 2, 4, and 8 h after surgery in the treatment group were significantly decreased, there were differences between two groups(P < 0.05). Compared with the control group, the numbers of nausea, vomiting, and restlessness in the treatment group were significantly decreased, and there were differences between two groups(P < 0.05). Compared with the control group, the time of first pressing analgesic pump was significantly increased, but the number of effective pressing was significantly reduced within 24 h after operation in the treatment group, and there were differences between two groups(P < 0.05). Conclusion Intravenous injection of Butorphanol Tartrate Injection before suture is helpful for postoperative analgesia and sedation after kidney transplantation, reduce the incidence of nausea and vomiting, can be safely used in anesthesia of renal transplantation patients.
引文
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[10]罗远国,李洪,张旭,等.多模式镇痛对肾移植患者术后疼痛及细胞因子的影响[J].重庆医学,2014,43(3):295-297.
[11]Chen Q,Shang Y,Xu Y,et al.Analgesic effect and pharmacological mechanism of fentanyl and butorphanol in a rat model of incisional pain[J].J Clin Anesth,2016(28):67-73.
[12]Nisa K,Lim S Y,Osuga T,et al.The effect of sedation with a combination of butorphanol and midazolam on quantitative contrast-enhanced ultrasonography of duodenum in healthy dogs[J].J Vet Med Sci,2018,80(3):453-459.
[13]Kaur J,Bajwa S J.Comparison of epidural butorphanol and fentanyl as adjuvants in the lower abdominal surgery:a randomized clinical study[J].Saudi J Anaesth,2014,8(2):167-171.
[14]彭伟,庞登戈.布托啡诺对妇科腹腔镜术患者苏醒期疼痛和躁动的影响[J].广西医学,2011,33(12):1610-1612.
[15]黄宇光,黄文起,李刚,等.酒石酸布托啡诺镇痛专家共识[J].临床麻醉学杂志,2011,27(10):1028-1029.
[2]Harding K,Mersha T B,Pham P T,et al.Health disparities in kidney transplantation for African Americans[J].Am JNephrol,2017,46(2):165-175.
[3]Commiskey S,Fan L W,Ho I K,et al.Butorphanol:effects of a prototypical agonist-antagonist analgesic on kappa-opioid receptors[J].J Pharmacol Sci,2005,98(2):109-116.
[4]Ding L,Zhang H,Mi W,et al.Effects of dexmedetomidine on anesthesia recovery period and postoperative cognitive function of patients after robot-assisted laparoscopic radical cystectomy[J].Int J Clin Exp Med,2015,8(7):11388-11395.
[5]Sardesai S P,Patil K N,Sarkar A.Comparison of clonidine and dexmedetomidine as adjuncts to intravenous regional anaesthesia[J].Indian J Anaesth,2015,59(11):733-738.
[6]Ricaurte L,Vargas J,Lozano E,et al.Anesthesia and kidney transplantation[J].Transplant Proc,2013,45(4):1386-1391.
[7]刘峰,刘秀珍,王恒林,等.地佐辛超前镇痛在肾移植患者麻醉中的临床应用[J].中国综合临床,2014,30(11):1130-1133.
[8]Nie Y,Liu Y,Luo Q,et al.Effect of dexmedetomidine combined with sufentanil for post-caesarean section intravenous analgesia:a randomised,placebo-controlled study[J].Eur J Anaesthesiol,2014,31(4):197-203.
[9]于向洋,贾莉莉,喻文立,等.羟考酮混合右美托咪定PCIA用于胰肾联合移植术后镇痛的效果[J].中华麻醉学杂志,2017,37(12):1429-1433.
[10]罗远国,李洪,张旭,等.多模式镇痛对肾移植患者术后疼痛及细胞因子的影响[J].重庆医学,2014,43(3):295-297.
[11]Chen Q,Shang Y,Xu Y,et al.Analgesic effect and pharmacological mechanism of fentanyl and butorphanol in a rat model of incisional pain[J].J Clin Anesth,2016(28):67-73.
[12]Nisa K,Lim S Y,Osuga T,et al.The effect of sedation with a combination of butorphanol and midazolam on quantitative contrast-enhanced ultrasonography of duodenum in healthy dogs[J].J Vet Med Sci,2018,80(3):453-459.
[13]Kaur J,Bajwa S J.Comparison of epidural butorphanol and fentanyl as adjuvants in the lower abdominal surgery:a randomized clinical study[J].Saudi J Anaesth,2014,8(2):167-171.
[14]彭伟,庞登戈.布托啡诺对妇科腹腔镜术患者苏醒期疼痛和躁动的影响[J].广西医学,2011,33(12):1610-1612.
[15]黄宇光,黄文起,李刚,等.酒石酸布托啡诺镇痛专家共识[J].临床麻醉学杂志,2011,27(10):1028-1029.