布托啡诺与芬太尼在腹腔镜全麻中的对照研究

目的 将布托啡诺作为一种全麻诱导用药应用于腹腔镜手术，并与芬太尼进行比较，观察评价其临床效果及应用可行性。 方法 60例ASA Ⅰ～Ⅱ级行全麻腹腔镜手术的患者，随机分为两组（n=30）：布托啡诺组（B组）和芬太尼组（F组）。诱导时B组静注布托啡诺40ug/kg，F组静注芬太尼4ug∕㎏，5min后两组均静注丙泊酚及顺苯磺酸阿曲库铵后行气管插管控制呼吸，术中以丙泊酚及七氟醚维持麻醉，术毕待病人自主呼吸恢复，清醒后拔管。记录注药前后、插气管导管前后、术中、术毕、拔管前后BP、HR、SpO2、PETCO2，记录术毕、拔管前后病人自主呼吸恢复情况、躁动情况及术毕至病人清醒拔管时间，记录清醒时及清醒后1h、2h、4h、8h、12h、16h、20h、24h病人疼痛程度，疼痛程度采用“视觉模拟评分法”（VAS）评定，记录24小时内不良反应发生率。 结果 布托啡诺静注后BP、HR与注药前比较无显著性差异（p>0.05），芬太尼静注后BP变化无显著性差异（p>0.05），但心率下降有显著性差异(p<0.05);两组插管后及术中较诱导前BP、HR变化无显著性差异（p>0.05），术毕及拔管前后B组BP、HR较术前差异无显著性（p>0.05），F组BP、HR升高明显（p<0.05），两组SpO2在注药前后、插管前后、术中、术毕、拔管前后变化均无显著性差异（p>0.05）。术毕至清醒拔管时间B组稍长于F组，但统计学分析无显著性差异（p>0.05），术毕及拔管前后躁动B组明显少于F组（p<0.05）。清醒后即刻及1h、2h、4h、8hVAS评分B组明显低于F组（p<0.05），清醒后12h、16h、20h、24hVAS评分B组仍低于F组，但两组差异无显著性（p>0.05）。术后恶心、呕吐、寒战发生率B组明显少于F组（p<0.05），头晕发生两组各1例，无胸闷、头痛、尿潴留、呼吸抑制发生。 结论 将布托啡诺应用于全麻诱导，对呼吸、循环影响均不大，围手术期生命体征平稳，术后疼痛反应轻，不良反应发生率低，可安全有效应用于全麻诱导。

Research on compareing butorphanol with fentanyl in general anesthesia for laparoscopic surgery

【Abstract】 Objective To observe and evaluate the clinical effectiveness and adoption by butorphanol being compared with fentanyl as the narcotic component of general anesthesia for laparoscopic surgery. Methods Sixty ASA Ⅰ～Ⅱ heathy women patients undergoing laparoscopic surgery under general anesthesia were divided randomly into two groups of thirty each.Butorphanol group(B, n=30) were received doses of butorphanol 40ug/kg and fentanyl group(F, n=30) were received doses of fentanyl 4ug∕㎏ to induction of anesthesia. After 5 min, both groups were received doses of propofol 2mg/kg and cisatracurium 0.15mg/kg,then tracheal intubation was administrated.Tracheal anesthesia was maintained with sevflurane and propofol.Recording BP,HR,SpO2,PETCO2 in the duration of operation and respiratory recovery and dysphoria after operation. Pain was assessed using visual analogue scares(VAS) at 1、2、4、8、12、16、20、24h after operation.Incidence of adverse effects was recorded in the first 24 hours after surgery . Results It demonstrated no significant change in BP and HR in group B（p>0.05）but significant reduction in HR in group F（p<0.05）after injection. BP and HR were significant higher in group F（p<0.05）but less significant change in group B（p>0.05）postoperation. SpO2 was less significant changed in the duration of operation.VAS at postoperative 1、2、4、8h were significant lower in group B than that in group F（p<0.05）and VAS at postoperative 12、16、20、24h have less statistical difference in two groups（p>0.05）. Incidence of postoperative nausea, vomit were significant lower in group B than that in group F（p<0.05）.There were no between-group differences in respiratory depression occurred. Conclusion As the narcotic component of general anesthesia, butorphanol have less significant effect to the breath and circularation,less postoperative pain and adverse effects, stable vital signs.