布托啡诺-眯达唑仑对硬膜外麻醉胃穿孔修补术牵拉反应的影响

目的：比较硬膜外麻醉下布托啡诺-咪达唑仑与哌替啶-异丙嗪抑制胃部手术牵拉反应的效果。方法：回顾性分析2010年3月至2012年1月本院收治的行穿孔修补手术的40例胃穿孔患者的临床资料，根据使用的药物不同分为2组：哌替啶-异丙嗪（DP）组和布托啡诺-咪达唑仑（BM）组，每组20例。在硬膜外麻醉效果满意后，DP组：哌替啶50mg和异丙嗪25mg混合于切皮前5min静脉注射；BM组：布托啡诺0．02mg／kg和咪达唑仑0．04mg／kg混合于切皮前5min静脉注射。观察2组患者术中出现牵拉反应的情况，计算抑制牵拉反应的有效率；并分别记录静注前（T2）、静注后5min（T2）、10rain（T2）、15min（T2）和术毕（T2）各时相点两组患者的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（Sp02）；采用警觉／镇静（OAA／S）评分评估2组患者术中镇静深度。结果：DP组和BM组患者术中抑制牵拉反应的有效率分别为50％和90％，两组比较，差异有统计学意义（P〈0．05）。T2和T3时相点，DP组患者的MAP、HR、SpO2与BM组比较，差异有统计学意义（P〈0．05）；两组患者的OAA／S评分比较，差异无统计学意义（P〉0．05）。结论：在硬膜外麻醉下，布托啡诺-咪达唑仑比哌替啶-异丙嗪更能有效地抑制胃部穿孔修补手术引起的牵拉反应，且对患者血流动力学的影响较小。

Effect of butorphanol-midazolam on traction reaction during epidural anesthesia for perforated gastric ulcer repair

Objective： To compare the efficacy and safety of intravenous butorphanol-midazolam （BM） and pethidine-promethazine （DP） on traction reaction during epidural anesthesia for perforated gastric ulcer repair. Methods： From March 2010 to January 2012, a total of 40 patients with perforated gastric ulcer were assigned randomly after satisfactory epidural anesthesia to receive BM （ butorphanol 0.02 mg ~ kg plus midazolam 0.04 mg · kg, n = 20） and to receive DP （pethidine 50rag plus promethazine 25 rag, n = 20）. All drugs in both groups were administrated intravenously 5 minutes before skin incision. The intraoperative traction reactions were observed in both groups to calculate the traction reaction block efficiency. The indicators of MAP, HR and SpO2 were documented before administration （T0）, 5 （T1）, 10 （T2 ） and 15 （ T3 ） minutes after administration and postoperation （ T4 ）. The OAA/S scoring system was adopted to evaluate the sedative depths of the patients in the 2 groups. Results ： The traction reaction block efficiency was 50% for the DP group and 90% for the BM group, with a significant between-group difference （P 〈 0.05 ）. The values of＇ MAP, HR and SpO2 at T2 and T3 were significantly different between the 2 groups （ P 〈 0.05 ）. there were no significant differences between the 2 groups in the OAA/S scores （P 〉 0.05）. Conclusion ： It is advisable to apply butorphanol-midazolam, which has limited influence on the patient＇ s hemodynamics, during epidural anesthesia to block the traction reaction, compared with pethidine-promethazine.