下腹部手术后硬膜外持续输注布托啡诺镇痛的临床观察

目的评价布托啡诺用于下腹部手术后硬膜外持续输注镇痛的效果以及不良反应。方法将60名采用蛛网膜下腔-硬膜外联合阻滞麻醉的择期下腹部手术患者,随机分为A、B、C组,每组20例。手术结束前30 mm,A、B组硬膜外注射布托啡诺1 mg,C组吗啡2 mg作为负荷剂量,术毕A、B、C组均将硬膜外导管连接一次性镇痛泵,A、B组术后镇痛液分别给予0.002%布托啡诺复合0.2%罗哌卡因、0.004%布托啡诺复合0.2%罗哌卡因,C组患者给予0.004%吗啡复合0.2%罗哌卡因。离开手术室后于4,8,12,24,48 h采用视觉疼痛模拟评分（VAS）和镇静评分（Ramsay）评分及记录48 h内患者恶心呕吐、皮肤瘙痒、呼吸抑制等不良反应。结果术后A组4、8、12 h VAS评分显著高于B、C组,4、8 h Ramsay评分低于B、C组,差异有统计学意义（P〈0.05）;而C组恶心、呕吐和皮肤瘙痒等不良反应显著多于A、B组（P〈0.05）。结论0.004%布托啡诺复合0.2%罗哌卡因用于下腹部手术硬膜外术后镇痛效果确切,且恶心、呕吐、皮肤瘙痒发生率低于吗啡。

Continuous epidural analgesia with butorphanol in patients after lower abdominal surgery

Objective To evaluate the analgesic and side effects of continuous epidural analgesia with butorphanol on patients after lower abdominal surgery. Methods Sixty patients, ASA Ⅰ and Ⅱ , undergoing lower abdominal surgery were randomly divided into group A.B and C（n = 20, each）. Loading dose of butorphanoi 1 mg in group A and B,and morphine 2 mg in group C were injected into epidural space 30 min before the end of operation. Epidural catheter was connected to the analgesic pump after operation, butorphanol 0. 002 % with ropivacaine 0.2 %, butorphanol 0. 004 % with ropivacaine 0.2% in group A and B respectively,morphine 0. 004% with ropivacaine 0.2% in group C was given. VAS.Ramsay scores and side effects were respectively recorded at 4, 8, 12. 24 and 48 h after operation. Results VAS in 4. 8, 12 hour after operation were higher and Ramsay in 4,8 hours were lower in group A than that in group B. C（P〈0.05）, while the side effects in group C were markedly higher than that in group A and B（P〈0. 05）. Conclusion Butorphanol 0. 004% with ropivacaine 0.2 % can provided the exact effect of postoperative epidurai analgesia for lower abdominal surgery, and side effects of nausea, vomiting and skin itching are less than that with morphine.