比较布托啡诺与吗啡用于女性痔手术硬膜外镇痛的不良反应

目的：比较布托啡诺与吗啡用于女性患者痔疮手术后硬膜外镇痛的不良反应。方法：择期痔疮手术后需硬膜外镇痛的女性患者100例，年龄22—45岁，体质量40—63kg，美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级，随机分成两组（n=50）：布托啡诺组（B组）和吗啡组（M组）。术后硬膜外镇痛均采用负荷量＋持续剂量＋自控给药的模式，负荷量：B组为布托啡诺1mg，M组为吗啡1mg，两组均持续剂量为2mL／h、自控剂量为每次0．5mL、间隔时间为15min，镇痛液配方为B组0．006％布托啡诺复合0．15％罗哌卡因100mL，M组0．006％吗啡复合0．15％罗哌卡因100mL。两组均在给负荷量前5min静脉注射昂丹司琼8mg。评估术后2（T1）、4（T2）、8（T3）、12（T4）、24（T5）和36h（T6）各时点的镇痛评分、镇静评分，观察术后36h镇痛期间患者恶心、呕吐、皮肤瘙痒、头晕等不良反应的发生情况。结果：两组术后各观察时点的镇痛评分（均〈3分）与镇静评分（2～4分），组间比较差异无统计学意义，但B组恶心（10％）、呕吐（0）、头晕（8％）等不良反应发生率明显低于M组（30％、18％、20％）（P〈0．05）。结论：布托啡诺用于女性患者痔手术后硬膜外镇痛，镇痛效果好，不良反应发生率比吗啡低。

Side effects of butorphanol versus morphine used for postoperative epidural analgesia among female patients after hemorrhoid surgery

Objective：To compare the side effects of butorphanol versus morphine used for postoperative epidural analgesia among female patients after hemorrhoid surgery. Methods： 100 female patients who necessitated epidural analgesia after elective hemorrhoid surgery （aged 22 to 45 years old, weighed 40 - 63 kg, ASA Ⅰ - Ⅱ ）, were randomly divided into two groups （ n = 50 each） to received butorphanol （ group B ） or morphine （ group M）. The postoperative epidural analgesia used loading dose ＋ controlled ＋ continuous mode of delivery. The loading dose in Group B was lmg butorphanol,and lmg morphine in group M. In the both groups, the continued dose was 2 mL/h, and the self-controlled dose was 0.5ml/time given by 15 rain intervals apart. The composition of analgesic formula was 100ml of 0. 006% butorphanol plus 0.15% ropivacaine in group B, and 100ml of 0. 006% morphine plus 0.15% ropivacaine in group M. Both groups received a 8mg intravenous bolus of ondansetron at 5min before the loading dose. Pain and sedation scores at various time points 2 （T1 ） ,4 （T2 ）, 8 （ T3 ）, 12 （ T4 ） ,24 （ T5 ） and 36h （ T6 ） postoperation ] were assessed. Nausea, vomiting, itchy skin, dizziness and other side effects were recorded during 36h of postoperative analgesia. Results： The postoperative pain scores（ all 〈3） and sedation scores（2 to 4） at each time point were not statistically different between groups. However, group B had lower incidence of nausea （ 10% ）, vomiting （0） and dizziness （ 8 % ） compared with group M （30%, 18%, and 20% ） （P 〈 0. 05 ）. Conclusion： Postoperative epidural analgesia with butorphanol in female patients after hemorrhoid surgery offers favorable analgesic and sedation effects, but a low incidence of side effects than morphine.