布托啡诺与吗啡用于胸科手术后硬膜外镇痛效果的比较

目的:比较布托啡诺与吗啡复合罗哌卡因用于胸科手术后硬膜外镇痛的效果及不良反应。方法:60例开胸手术患者,ASAⅠ~Ⅱ级,年龄43~76岁,体重42~78 kg。随机均分为两组:布托啡诺组(A组)、吗啡组(B组),A组术后持续泵注0.004%布托啡诺+0.125%罗哌卡因,B组术后持续泵注0.004%吗啡+0.125%罗哌卡因行术后硬膜外自控镇痛(PCEA),病人自控镇痛泵设置均为:容量100 ml,背景流量2 ml/h,单次负荷量1 ml,锁定时间15 min。观察术后4 h、8 h、12 h、16 h、24 h、36 h病人的镇痛、镇静评分、生命体征、副作用和病人的满意度。结果:两组各时点VAS评分差异无统计学意义;A组各时点镇静评分均显著高于B组(P<0.05);B组恶心、呕吐、皮肤瘙痒等发生率较A组高;A组病人对PCEA满意率高于B组(P<0.05)。结论:布托啡诺、吗啡PCEA用于胸科手术术后镇痛均可取得满意效果,但布托啡诺较吗啡的不良反应少,更适合胸科手术术后镇痛。

Comparing the efficacy of butorphanol and morphine for epidural analgesia after thoracic surgery

Objective：To compare the efficacy and adverse effects between butorphanol plus ropivacaine and morphine plus ropivacaine for epidural analgesia after thoracic surgery.Methods：Sixty patients undergone thoracotomy（ASA Ⅰ～Ⅱ,aged 43～76 years,weighing 42～78 kg） were randomized into 2 groups of butorphanol（Group A） and morphine（Group B）.Group A received continuous infusion of 0.004% butorphanol ＋ 0.125% ropivacaine,and group B were given infusion of 0.004% morphine ＋0.125% ropivacaine） for patient-controlled epidural analgesia（PCEA）after the procedure.PCEA infusion pump was set with capacity of 100mL by background infusion of 2mL / h,a single load dose of 1mL and lockout interval of 15min.Postoperatively,all patients were observed at 4 h,8 h,12 h,16 h,24 h and 36 h,respectively,for visual analogue scale（VAS）,Ramsay sedative scale（RSS）,vital signs,adverse effects and their satisfaction.Results：No statistical difference was found regarding the VAS scores at each time point between the two groups,yet RSS in group A were significantly higher than that of group B at each time point（P0.05）.Nausea,vomiting and itch of skin were more commonly seen at each time point in group B as compared with group A.Contrarily,patients of group A appeared more satisfied with PCEA（P0.05）.Conclusion：Butorphanol and morphine may produce favorable analgesic effect on PCEA for patients undergone thoracotomy.Nevertheless,butorphanol seems less submitted to adverse reaction and preferable to clinical use for pain relief.