布托啡诺用于老年患者开胸术后患者自控静脉镇痛的临床观察

目的比较吗啡、芬太尼、布托啡诺用于老年患者开胸术后患者自控静脉镇痛（PCIA）的效果和不良反应。方法选择普胸手术患者90例。随机分为吗啡组（A组），芬太尼组（B组），布托啡诺组（c组），每组30例。3组患者全麻用药方案相同。术毕3组患者均安置镇痛泵。镇痛配方：A组为吗啡40mg、恩丹西酮8mg加生理盐水至100ml；B组为芬太尼0．5mg、恩丹西酮8mg加生理盐水至100ml；C组为布托啡诺6mg、恩丹西酮8mg加生理盐水至100ml。参数设置均为：背景剂量2ml／h，PCA2．0ml，锁定时间15min。分别于患者苏醒拔管后4、12、24、48h观察并记录镇痛评分、镇静评分、各时点的Spoz、每分钟通气量（MV）、潮气量（Vt）、呼吸频率（RR）数值。观察各组的主要不良反应。结果3组患者均能获得满意的镇痛效果。其中以A组镇痛效果最佳，与术前比较，3组患者呼吸频率（RR）均增快，Vt有不同程度的降低，但B组较A组和C组变化明显（P〈0．05）。恶心呕吐发生率C组明显低于A组和B组（P〈0．05）。嗜睡发生率B组明显高于A组和C组（P〈0．05）。皮肤瘙痒发生率A组明显高于B组和C组（P〈0．05）。结论吗啡、芬太尼、布托啡诺用于老年患者开胸术后PCIA均能获得满意效果，尤以布托啡诺为佳。

Butorphanol for postoperative PCIA in patient with thoracic surgery

Objective To compare the effects and adverse reactions of morphine, fentanyl, butorphanol for elderly patients undergoing postoperative PCIA after thoracic surgery. Methods Ninety patients undergoing thoracic surgery were randomly divided into morphine group （group A）, fentanyl group （group B）, and butorphanol group （group C）, 30 cases in each. The anesthesia regi- men was same in the 3 groups. Analgesic formula in group A was morphine 40 mg, ondansetron 8mg and normal saline added to 100ml; in group B fentanyl 0.5mg,ondansetron 8mg and normal saline to 100ml; in group C butorphanol 6mg,ondansetron 8mg and normal saline to 100ml. Background dose was 2 ml/h, PCA 2.0 ml, lock time 15 min. After extubation 4, 12, 24, 48 h, pain scale, sedation score, SpO2, minute ventilation （MV）, tidal volume （Vt）, respiratory rate （RR） and adverse reac- tions were observed. Resolts Satisfactory analgesia can be achieved in all of the three groups. The best analgesic effect was in group A. Compared with the preoperative, respiratory rate （RR） was increased in the three groups, Vt decreased in varying degrees, but the changes were significantly in group B than those in group A and group C （P〈0.05）. The incidence of nausea and vomiting was significantly lower in group C than those in group A and group B （P〈0.05）. The incidence of drowsiness was significantly higher in group B than those in group A and group C （P〈0.05）. The incidence of pruritus was significantly higher in group A than those in group B and group C （P〈0.05）. Conclusion Satisfactory results can be obtained with morphine, fentanyl or butorphanol for postoperative PCIA after thoracotomy in elderly patients, especially better with butorphanol.