比较布托啡诺、芬太尼及芬太尼联合曲马多用于老年患者术后镇痛的临床效果

目的研究布托啡诺用于老年患者术后静脉镇痛的疗效及不良反应。方法60例择期行上腹部手术的老年患者,随机均分为布托啡诺组(B组)、芬太尼组(F组)及芬太尼联合曲马多组(FT组),分别接受持续静脉镇痛。记录并比较术后48h内疼痛视觉模拟评分(VAS)、Ramsay镇静评分及不良反应。结果三组术后镇痛效果VAS组内比较差异无统计学意义。但术后6hF组和B组的VAS明显低于FT组(P<0.05);术后12h,B组的VAS仍低于FT组(P<0.05)。B组术后0.5、6、12h Ramsay镇静评分明显高于F组(P<0.05)。B组恶心呕吐发生率明显低于FT组(P<0.05)。结论布托啡诺可用于老年患者术后静脉镇痛。     

Opiate induced feeding is not dependent on the hippocampus

It has been shown that spreading depression of the hippocampus can elicit feeding, and that several opioid peptides elicit spreading depression when injected into the hippocampus. To determine whether such depression is the primary mechanism by which opiates induce feeding, we tested the feeding effects of naloxone, an opiate antagonist, and butorphanol tartrate, a kappa-sigma agonist, on feeding in rats with and without hippocampal lesions. Naloxone tended to reduce intake approximately equally in the two groups. Similarly, the doses of butorphanol that increased intake in sham rats were equally effective in lesioned rats. It was concluded that the hippocampus is not the major structure mediating opiate-induced feeding.     

The effects of butorphanol on baroreflex control of heart rate in man

The effects of butorphanol injection on baroreflex control of heart rate were investigated using both pressor and depressor tests in eighteen adult patients. Baroreflex sensistivity was attenuated after butorphanol injection in the pressor test using phenylephrine, whereas it was unchanged in the depressor test using nitroglycerine. No resetting of the baroreflex occurred after butorphanol injection. After the administration of butorphanol, plasma epinephrine and norepinephrine levels increased. These results suggest that it is safe to use butorphanol clinically even when a reduction in blood pressure due to hypovolemia or unclamping of the major artery is expected and that it is disadvantageous to administer the drug when an increase in blood pressure due to cross-clamping of the major artery is predicted.(Wajima Z, Inoue T and Ogawa R: The effects of butorphanol on baroreflex control of heart rate in man. J Anesth 7: 411--418, 1993)     

Effects of diltiazem,a Ca2+ channel blocker,on naloxone-precipitated changes in dopamine and its metabolites in the brains of opioid-dependent rats

The effects of diltiazem, an L-type Ca²⁺ channel blocker, on naloxone (an opioid receptor antagonist)-precipitated withdrawal signs and changes in extracellular levels of dopamine (DA) and its metabolites in various brain regions of morphine (a -opioid receptor agonist) or butorphanol (a// mixed opioid receptor agonist) dependent rats were investigated using high performance liquid chromatography fitted with an electrochemical detector (HPLC-ED). Rats were rendered opioid-dependent by continuous intracerebroventricular (ICV) infusion with morphine (26 nmol/µl per h) or butorphanol (26 nmol/µ1 per h) for 3 days. The expression of physical dependence produced by these opioids, as evaluated by naloxone (5 mg/kg, IP)-precipitated withdrawal signs, was reduced by concomitant infusion of diltiazem (10 and 100 nmol/µl per h). Under the same condition, naloxone decreased the levels of: DA in the cortex, striatum, and midbrain; 3,4-dihydroxyphenylacetic acid (DOPAC) in the cortex, striatum, limbic areas, and midbrain; and homovanilic acid (HVA) in the striatum, limbic areas, and midbrain regions. In animals rendered dependent on butorphanol, the results obtained were similar to those of morphine-dependent rats except for the changes in DOPAC levels. Furthermore, concomitant infusion of diltiazem and opioids blocked the decreases in levels of DA, DOPAC, and HVA in a dosedependent manner. These results suggest that the augmentation of intracellular Ca²⁺ mediated through L-type Ca²⁺ channels during continuous opioid infusion results in a decrease in extracellular levels of DA and its metabolites in some specific regions, which are intimately involved in the expression of withdrawal syndrome precipitated by naloxone.     

O.2%左旋布比卡因硬膜外持续背景输注期间不同药物对PCA效应的影响

目的比较硬膜外持续背景输注0·2%左旋布比卡因期间布托啡诺、氯诺昔康和吗啡患者静脉自控镇痛(PCIA)的临床效应和不良反应。方法选择择期经腹子宫全切手术患者60例(ASAⅠ~Ⅱ级),随机分为3组:布托啡诺组(B组)、氯诺昔康组(L组)和吗啡组(M组)。采用双泵法行双盲对照观察,第一泵:3组均为硬膜外持续输注0·2%左旋布比卡因4ml/h;第二泵:B组以布托啡诺PCIA强化,L组以氯诺昔康PCIA强化,M组以吗啡PCIA强化。镇痛效应对术后1,2,4,8,12,16,20及24h采用视觉模拟评分(VAS)、Ramesay镇静评分、术后运动神经阻滞恢复评分(改良Bromage分级)和患者对PCA综合满意度评分,记录术后0~1h,~2h,~4h,~8h,~12h,~16h,~20h,~24h PCA泵的按压次数(D1)与实际进入次数(D2),并记录肛门排气时间及可能出现的不良反应。结果3组患者的一般情况相似,24h硬膜外左旋布比卡因的使用剂量为192mg,3组患者未按压PCA泵的患者各为1例(5%),静脉用药量分别为(0·82±0·55)mg(B组),(11·40±2·80)mg(L组),(4·70±3·50)mg(M组),在相同时间段内3组间VAS、Ramesay镇静评分、Bromage分级及D1/D2值均相似。结论在0·2%左旋布比卡因硬膜外持续输注(4ml/h)的基础上,新型阿片受体激动拮抗药布托啡诺与氯诺昔康和吗啡静脉PCA均能达到辅助镇痛的效果,静脉PCA布托啡诺与吗啡的镇痛效应比例约为1∶5。     

预注布托啡诺对依托咪酯在全麻诱导时导致肌阵挛的影响

目的:探讨预注布托啡诺对预防依托咪酯导致肌阵挛的效果。方法:拟在全麻下择期手术患者180例,ASAⅠ或Ⅱ级,男85例,女95例,年龄20~65岁,体重42~59 kg,随机分为布托啡诺组(B组)、舒芬太尼组(S组)和对照组(N组),每组各60例。B组给予布托啡诺20μg/kg(总量不大于2 mg);S组给予舒芬太尼0.2μg/kg、N组给予同容积的生理盐水,1 min后三组患者均静注依托咪酯0.3 mg/kg,注射时间30 s,并持续观察2 min,观察痉挛发生情况和评估严重程度。结果:诱导期间三组患者的BP、HR差异无统计学意义,所有患者Sp O297%;与N组比较,B组、S组患者肌阵挛1、2、3级例数明显减少,肌阵挛发生率明显降低(P0.05)。结论:预注20μg/kg布托啡诺可有效减少依托咪酯诱导时导致的肌阵挛发生。     

酒石酸布托啡诺、地佐辛与盐酸托烷司琼在镇痛泵内配伍的稳定性考察

目的:考察酒石酸布托啡诺、地佐辛、盐酸托烷司琼在0.9%氯化钠注射液中的配伍稳定性。方法:模拟临床实际用药的配伍浓度和使用环境,检测0,1,4,6,24,48,72 h外观、pH、相对百分含量的变化。结果:酒石酸布托啡诺、地佐辛与盐酸托烷司琼的配伍液在72 h内pH未出现明显变化,外观稳定,各药品成分相对百分含量也没有明显变化。结论:在室温条件下,酒石酸布托啡诺、地佐辛与盐酸托烷司琼在0.9%氯化钠注射液中72 h内保持稳定。因此,酒石酸布托啡诺(6 mg)、地佐辛(20 mg)与盐酸托烷司琼(10 mg)可以配伍使用,在镇痛泵内配伍稳定。     

帕瑞昔布钠对乳腺癌根治术后布托啡诺病人自控静脉镇痛时细胞免疫功能的影响

目的 评价帕瑞昔布钠对乳腺癌根治术后布托啡诺病人自控静脉镇痛(PCIA)时细胞免疫功能的影响.方法 择期行乳腺癌改良根治术女性病人60例,ASA分级Ⅰ或Ⅱ级,年龄36～ 60岁,体重48 ～ 82 kg,采用随机数字表法,将其分为2组(n=30):对照组(C组)和帕瑞昔布钠组(P组).术毕采用布托啡诺10 μg/kg行PCIA,背景输注速率2 ml/h,PCA量0.5 ml,锁定时间15 min.P组分别于术毕、术后12、24和36 h时静脉注射帕瑞昔布钠40 mg,C组给予等容量生理盐水.术后维持VAS评分≤4分;VAS评分≥5分时,静脉注射布托啡诺进行镇痛补救.分别于麻醉诱导前5 min、切皮后2h、术后6h、1、3和7d时,采集右颈内静脉血样,采用流式细胞仪检测T淋巴细胞亚群(CD3+、CD4+、CD8+)和NK细胞的水平,计算CD4+/CD8+.分别于术后2、6、12、24和48 h时,记录镇痛泵总按压次数、有效按压次数和镇痛补救药物用量.记录不良反应发生情况.结果 与C组比较,P组镇痛泵总按压次数和镇痛补救药物用量减少,镇痛泵有效按压次数增多,术后ld时CD3+、CD4+、CD4+/CD8+和NK细胞水平降低(P＜0.05),不良反应发生率差异无统计学意义(P＞0.05).结论 帕瑞昔布钠可增强术后布托啡诺PCIA的效果,减少其用量,从而改善乳腺癌根治术病人术后细胞免疫功能.     

右美托咪定联合布托啡诺用于无创正压通气患者的镇静镇痛效果

目的:观察右美托咪定联合布托啡诺用于无创正压通气患者的镇静镇痛效果。方法:选择2014年10月至2015年10月成都大学附属医院重症监护病房收治的无创正压通气患者80例,按随机数字表法分为试验组与对照组。对照组给予右美托咪定4μg/m L,以0.1~0.2μg·kg-1·h-1静脉泵注。试验组在对照组基础上给予200 mg/L的布托啡诺以0.01μg·kg-1·h-1静脉泵注。两组均持续镇静达到Ramsay评分3~5分。观察两组患者治疗前后心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、动脉血氧分压(Pa O2)的变化,记录药物起效时间,比较两组患者右美托咪定用量、气管插管率、不良事件发生率。结果:两组治疗后的HR、MAP、RR均较治疗前明显降低(P<0.05);Pa O2较治疗前明显升高(P<0.05);试验组HR、MAP、RR改善程度优于对照组(P<0.05)。试验组达到Ramsay评分3~4分的起效时间,较对照组明显缩短(45.37±5.17 vs.76.24±11.82,P<0.05);试验组右美托咪定用量少于对照组(223±24.17 vs.257±18.09,P<0.05)。患者气管插管率、不良反应发生率,试验组均低于对照组(12.5%vs.25%;10%vs.17.5%,P<0.05)。结论:右美托咪定联合布托啡诺应用于无创正压通气患者镇静镇痛,可减少右美托咪定用量,减少不良反应,同时改善通气效果,改善临床疗效。     

右美托咪定复合布托啡诺对妇科腹腔镜手术患者术后镇痛的效果观察

目的：观察右美托咪定复合布托啡诺用于妇科腹腔镜手术后患者静脉自控镇痛（ PCIA）的安全性和有效性。方法择期全身麻醉下行妇科腹腔镜手术的患者80例,经患者知情同意,按照数字表法随机分为2组,每组40例。右美托咪定复合布托啡诺组（ DB组）患者麻醉诱导后,静脉泵注右美托咪定0．5μg／kg,对照组泵注等量生理盐水。2组患者手术结束前15 min均给予布托啡诺1．0 mg。术后行自控静脉镇痛（PCIA）：对照组使用布托啡诺0．125 mg／kg（最大剂量不超过10 mg）, DB组在使用布托啡诺基础上加入右美托咪定0．1μg／（kg· h）（最大剂量不超过300μg）。观察并记录术后1、2、6、12、24 h患者疼痛视觉模拟（ VAS）评分和镇静评分、24 h内镇痛泵按压次数、追加镇痛药次数、不良反应以及患者的总体满意度。结果DB组患者术后1、2、6、12、24 h静息和活动时VAS评分均显著低于对照组,差异有统计学意义（ P＜0．05）;DB组患者镇痛泵按压次数少于对照组,布托啡诺用量明显降低,差异有统计学意义（P＜0．05）。与对照组比较,DB组患者恶心呕吐、眩晕发生率显著降低,差异有统计学意义（P＜0．05）,对术后镇痛的总体满意度较高,差异有统计学意义（P＜0．05）;2组患者均未发生心动过缓、呼吸抑制等不良反应。结论右美托咪定可增强布托啡诺对妇科腔镜手术患者术后镇痛效果,减少布托啡诺消耗量,降低不良反应发生率,提高患者满意度。