布托啡诺预防瑞芬太尼麻醉后痛觉过敏的临床研究

目的 探讨布托啡诺预防瑞芬太尼麻醉后痛觉过敏的效果及安全性.方法 选择2012年1月至2013年6月在深圳市龙岗人民医院经瑞芬太尼麻醉后进行腹腔镜下子宫肌瘤剔除术患者80例,美国麻醉医师协会分级为Ⅰ～Ⅱ级,所有患者根据其手术顺序平均分为布托啡诺镇痛组和生理盐水对照组,麻醉方法均为静吸复合全麻,术中采用丙泊酚、瑞芬太尼持续静脉泵注及吸入七氟烷维持麻醉.手术结束后,布托啡诺镇痛组患者立即静脉注射布托啡诺25 μg/kg,生理盐水对照组静脉注射等量的生理盐水.分别于患者苏醒后30、60、120 min行视觉模拟疼痛评分、Ramsay镇静评分,并记录两组患者恢复自主呼吸时间、苏醒时间、拔管时间以及术后要求镇痛患者例数、镇痛药物用量和麻醉苏醒后3 h内的不良事件.结果 两组患者的手术时间、手术后恢复自主呼吸时间、苏醒时间、拔管时间、瑞芬太尼总用量以及各时点的Ramsay评分差异均无统计学意义（P＞0.05）,布托啡诺镇痛组患者各时点的VAS评分均显著低于生理盐水对照组患者,苏醒后3 h内布托啡诺镇痛组患者的恶心、呕吐、寒战的发生率明显更低,且术后要求镇痛的患者比例及镇痛药物的用量均更低,差异均有统计学意义（P＜0.05）.两组患者均未发现有精神症状、呼吸抑制以及低氧血症现象发生.结论 布托啡诺能够安全、有效地预防瑞芬太尼麻醉后痛觉过敏现象的发生.

Clinical Research of Butorphanol in Preventing Hyperalgesia after Remifentanil Anesthesia

Objective To assess the effect and safety of butorphanol in preventing hyperalgesia after remifentanil anesthesia. Methods During Jan. 2012 and Jun. 2013,80 patients（ American Society of Anes- thesiologistes Grading I - II grade） from Shenzhen Longgang People＇s Hospital, who underwent remifentanil anesthesia for laparoscopic myomectomy were selected and assigned into two groups equally accolxling the operation turn. Inhalation anesthesia was adopted in both groups, propofol and remifentanil continuous intra- venous infusion and inhalation of sevoflurane were used to maintain anesthesia during operation. The patients in observation group were administrated butorphanol 25 Ixg/kg by intravenous injection, while the control group was given the same amount of physiological saline. VAS and Ramsay scores were assessed at 30,60 and 120 min after awakeness. Postoperative recovery time of spontaneous breath, the time of awakeness and extu- bation,the number of requiring tramadol, and the dosage of tramadol, as well as the adverse reactions within 3 h after recovery from anesthesia were recorded. Results There was no significant differences between the two groups in Ramsay score and postoperative recovery time of spontaneous breath, the time of awakeness and extubation, and the total amount of the remifentanil （ P 〉 0.05 ）. The postoperative VAS scqres and the adverse reactions （nausea, vomit and shiver）, and the number of requiring tramadol and the tramadol dosage used in control group were significantly higher than in butorphanol group （ P 〈 0.05 ）. Mental symptoms, respiratory depression, and the phenomenon of hypoxemia were not observed in either of the groups. Conclusion Butorphanol can effectively and safely prevent the occurrence of hyperalgesia after remifentanil anesthesia.