布托啡诺应用于瑞芬太尼静脉麻醉术后痛觉过敏的观察

目的观察布托啡诺对瑞芬太尼所致术后痛觉过敏的影响。方法上腹部择期手术患者120例,ASAⅠ～Ⅱ级,随机分为4组,均采用静脉复合麻醉加气管插管,术中持续静脉输注瑞芬太尼和异丙酚,间断给予阿曲库胺维持麻醉。关腹前10 min分别静脉注射布托啡诺20μg kg-1（A组,n=30）、30μg kg-1（B组,n=30）、40μg kg-1（C组,n=30）,对照组给予芬太尼1μg kg-1（D组,n=30）。记录各组苏醒时间、拔管时间、拔管时患者的血流动力学指标、拔管后的VAS评分、Ramsay评分及要求镇痛距离拔管的时间、拔管后患者恶心呕吐、呼吸抑制及烦躁等不良反应。结果拔管时的血流动力学指标4组比较无统计学意义（P〉0.05）;苏醒时间及拔管时间D组最长,恶心呕吐发生率D组最高。苏醒后VAS评分A组最高,B组和C组次之,B、C 2组间比较无统计学意义,VAS评分D组最低,D组与A、B、C 3组比较有统计学意义（P〈0.05）。Ramsay评分A组最低,C组最高,C组与B组比较有统计学意义（P〈0.05）。结论 30μg kg-1布托啡诺于手术结束前10 min静脉注射可安全有效减轻瑞芬太尼麻醉后痛觉过敏。

Effect of butophanol on postoperative hypergesia after remifentanil anesthesia

Objective To investigate the effect of butophanol on postoperative remifentanil-induced hyperalgesia.Methods A total of 120 cases of upper abdominal surgery,ASAⅠ-Ⅱclass were randomly divided into 4 groups,using intravenous anesthesia plus intubation,continuous intravenous injection of remifentanil and propofol and intermittent atracurium to maintain anesthesia.We gave 20 μg ？ kg-1（group A,n=30）,30 μg ？ kg-1（group B,n=30）,and 40 μg ？ kg-1（group C,n=30） of butophanol intravenous injection 10 min before the abdominal closure.A control group was given fentanyl 1 μg ？ kg-1（group D,n=30）.The time of recovery and extubation,hemodynamic parameters of extubation time,the VAS pain score and Ramsay score after the extubation and the time of requirements of analgesia from the extubation,adverse reactions with nausea and vomiting and respiratory depression dysthesia after the extubation were recorded.Results There was no statistical significance in hemodynamic parameters of the extubation（P 0.05）.Group D had the longest awake and extubation time and the highest incidence of nausea and vomiting.Group A had the highest VAS score after recovery and that of group B and C was lower.There was no statistical significance between group B and C.Group D had the lowest VAS score.Group C had the highest Ramsay score while group A had the lowest Ramsay score.Conclusion Butophanol（30 μg ？ kg-1） intravenous injection 10 min before the end of surgury is safe and effective in reducing the hyperalgesia after remifentanil anesthesia.