诺扬在腹腔镜胆囊切除术超前镇痛中的应用

目的评价诺扬(酒石酸布托啡诺)在腹腔镜胆囊切除术中超前镇痛的临床疗效及不良反应发生情况。方法选择ASAⅠ～Ⅱ级择期行腹腔镜胆囊切除术的患者40例,随机分为4组,每组10例。A组:气管插管前给予诺扬1mg静注。B组:气管插管前给予凯纷50 mg静注。C组:手术结束时给予诺扬1mg静注。D组:对照组,不使用任何镇痛药。用视觉模拟评分(VAS)系统评定术后0、1、2、3、4 h的疼痛程度。同时用Ram-mesay系统进行术后5、10、15、20 min的镇静评分。记录患者追加镇痛药及出现不良反应的情况。结果D组在各时点的VAS评分均高于其他3组,同时镇静评分低于其他3组。C组VAS评分在各时点均高于A组、B组。A组与B组在各时点差异无统计学意义(P>0.05)。C组在15、20 min时点的镇静评分高于A组和B组(P<0.05)。A组在5、10 min时的镇静评分高于B组、C组(P<0.05)。在其余时段各组差异无统计学意义(P>0.05)。四组均未见明显不良反应。结论诺扬用于腹腔镜胆囊切除术超前镇痛效果确切,不良反应小,且与其他超前镇痛药物比较有较好的镇静作用,可以减少术后躁动的发生。

Application of butorphanol tartrate on patients undergoing laparoscopic cholecystectomy for preemptive analgesic

Objective To evaluate the preemptive analgesic effect and side effect of butorphanol tartrate on laparoscopic cholecystectomy.Methods40 patiens of ASAⅠ～Ⅱ undergoing laparoscopic cholecystectomy were randomized into 4 groups(10 cases in each group).Patients in group A were injected butorphanol tartrate 1 mg intravenously,patients in group B were injected flurbiprofen axetil 50 mg before intubation,and patiens in group C were injected butorphanol tartrate 1 mg at the end of surgery,nothing was given to group D.The analgesic effect was evaluated by VAS score at 0,1,2,3 and 4 h after surgery.Meanwhile,the score of sedation was evaluated by Rammesay systerm at 5,10,15 and 20 min after surgery.ResultsThe VAS scores of group D at each time point were significantly higher than other groups,and the sedation scores were lower(P<0.05).The VAS scores of group C were significantly higher than group A and B at all time points(P<0.05).There was no significant difference between group A and B(P>0.05).The sedation scores of group C were significantly higher than group A and B at the points of 15 and 20 min(P<0.05).The sedation scores of group A were higher than group B and C at the points of 5 and 10 min(P<0.05).There was no significant difference between all groups at other time points.No significant side effect was found.ConclusionPreemptive analgesic with butorphanol tartrate is effective and safe in patients undergoing laparoscopic cholecystectomy.Compared with other drugs in preemptive analgesic,butorphanol tartrate was more effective in sedation,which can reduce the restlessness after surgery.