布托啡诺用于日间手术腹腔镜胆囊切除的可行性研究

目的 评估布托啡诺用于日间手术腹腔镜胆囊切除的临床效果及安全性.方法 选择年龄18~65岁,BMI 18~28 kg/m2,ASAⅠ~Ⅱ级,全身麻醉下行日间手术腹腔镜胆囊切除的患者60例,随机分为布托啡诺组(B组)30例和对照组(C组)30例.麻醉诱导前3 min两组患者分别静脉注射布托啡诺1 mg和生理盐水1 ml,之后均给予丙泊酚血浆靶浓度3 μg/ml麻醉诱导,患者入睡后分别给予芬太尼0.2 μg/kg、罗库溴铵0.6 mg/kg,行气管内插管.术中给予丙泊酚血浆靶浓度2~5 μg/ml、瑞芬太尼0.1~0.2 μg·kg-1·min-1全凭静脉麻醉,术毕停气腹即刻停药.观察并记录患者诱导时静脉注射部位是否疼痛及疼痛严重程度,诱导前后生命体征,手术时间、苏醒时间及定向力恢复时间,术后疼痛评分及不良反应.结果 B组丙泊酚注射痛发生率及严重程度均较C组降低(P<0.05);术后疼痛评分B组明显低于C组(P<0.05);B组恶心和寒战不良反应较C组显著减少(P<0.05);所有患者均符合日间手术标准,于术后24 h内出院.结论 布托啡诺可安全用于日间手术腹腔镜胆囊切除的患者,并且可以为患者提供更满意的麻醉及术后镇痛效果,减少不良反应的发生.

Feasibility analysis of butorphanol used in day surgery of laparoscopic cholecystectomy

Objective To evaluate analgesic effect and safety of Butorphanol used in day surgery of laparoscopic eholecystectomy. Methods Sixty ASA I-I1 adults,aged from 18 to 65 whose BMI was 18 - 28 kg,/m2, undergoing day surgery of laparoscopie eholecystectomy were randomly assigned into 2 groups of 30 each, Butorphanol group（ Group B ）and comparison group （Group C ）. 3 minutes before anesthesia induction, Group B reeeived Butorphanol 1 mg, Group C received normal saline 1 ml, then both groups of patients were induced with propofol TCI at a target concentration of 3 μg/ml. After patients＇ awareness disappeared, 0. 2 μg/kg bolus of Fentanyl and a 0. 6 mg/kg bolus of Rocuronium were administered intravenously before endotracheal intubation： During the surgery, kept the propofol TCI at a target concentration of 2-5 μg/ml and continuous intravenous infusion Remifentanil with mieromedicine infusion-pump until pneumoperitoneum was stopped. Propofol injection pain incidence and severity at the intravenous injection site, vital sign before and after induction, operating time, awakening time, orientation recovery time, postoperative pain score and adverse reactions were observed and recorded. Results A significant reduction in the injection pain incidence and severity during propofol intravenous injection was observed in group B compared with Group C （ P 〈 0. 05 ）. Postoperative pain seore of Group B was significantly lower than that of Group C （ P 〈 O. 05 ）. Adverse reactions ineluding nausea and shiver occurence rates were reduced signifieantly in Group B compared with Group C （P 〈 0.05 ）. All of the patients met with day surgery standard and discharged within 24 hours. Conclusions Butorphanol can be used safely in day surgery of laparoscopic cholecystectomy, it can reduce propofol injection pain incidence and severity,it can also get better effect in postoperative analgesia, and cause less adverse reactions.