酒石酸布托啡诺与芬太尼用于腹部手术后静脉镇痛（PCIA）的临床观察

目的观察腹部手术后酒石酸布托啡诺与芬太尼用于病人自控静脉镇痛（PCIA）的镇痛效果和副作用。方法择期下腹部手术50例ASAⅠ-Ⅱ级，随机分为芬太尼组（F组n=25），芬太尼6mg＋氟哌啶5mg＋生理盐水，稀释至100ml：布托啡诺组（B组n=25），布托菲诺8mg＋氟哌啶5mg＋生理盐水，稀释至100ml。两组病人均在全麻下手术，术前用药苯巴比妥钠0．1mg，阿托品0．5mg，麻醉诱导：布托啡诺O．02mg．kg-1，芬太尼2μg．kg-1，丙泊酚2mg．kg-1，阿曲库铵O．5mg．kg-1，麻醉维持：丙泊酚6mg．kg-1．h-1，阿曲库铵O．5mg．kg-1h-1，吸入异氟醚1％。手术结束后，B组静注布托啡诺1mg，F组静注芬太尼0．1mg作为负荷量，然后接静脉PCIA泵，参数设定：输入速度2mg．h-1自控剂量2ml／次，锁定时间30min。用视觉模拟评分法（VAS）评价镇痛效果，用镇静评分法（RSS）评价镇静效果，同时观察两组病人术后镇痛并发症。结果两组病人镇痛效果都较为满意B组VAS评分低于F组，但无统计学意义（p〉0．05），B组RSS评分低于F组但无统计学意义（p〉0．05）。B组BCS评分高于F组（p〈0．05）。B组恶心，呕吐，瘙痒，呼吸抑制等并发症少于F组（p〈0．01）。结论酒石酸布托啡诺静脉术后镇痛效果可靠副作用少，可以安全有效应用于临床。

Effects and side effect of postoperative analgesia patient- centrolled- intravenous- analgesia PCIA) of butorphanol compared with fentanyl in abdominal surgery.

Objective To investigate the efficacy and side effects of butorphanol compared with fentanyl in postoperative analgesia patient-controlled-intravenous-analgesia（PCIA） . Methods Fifty patients ASA status Ⅰ-Ⅱschedule abdominal surgery under general anesthesia, randomly assigned to two group： Fentanyl group （F group n =25 ） fentanyl 0.6mg ＋ ha10peridol 5mg ＋ NS 100ml： butorphanol group（ B group n=25） 8mg ＋ ha10peridol 5mg＋ NS100ml. premedication included Phenobarbital 0.1g and Atropine 0.5mg im . Anesthesia was induced with butorphanrl 0.02mg.kg-1, propofol 2mg.kg-1 and atracurium 0.5mg.kg-1, Maintained with continuous intravenous infusion of propofol 6mg.kg-1.h-1, atracurium 0.6mg.kg-1 .h-1, supplemented with inhalation of 1% isoflurane. At the end of operation a 10ading dose of butorphanol lmg of B group and fentanyl 0.1 mg ofF group was given, A 10ading dose of 2ml fo110wed by continuous infusion of 2ml/h, superimposed by boluses of 2ml with a 10ck-out time of 30min. Visual ana10gue score （VAS） and Observer＇s assessment of alertness/sedation （OAA/S） were evaluated, and side effects such as nausea, vomiting, somnolence, and urinary retention were also observed. Results The analgesia efficacy was sufficient in both group, while the VAS score was 10wer in group F but not statistically significant compared with that in group B （ p〉0.05 ）. The OAA/S score was 10wer in group F but not statistically significant compared with that in group B （p〉0.05）. The BCS score was higher in group B significant compared with that in group F （p〈0.05）. The side effects was 10w in group B than group F （ p〈0.05）. No evidence of serious respiratory depression was seen in any patient. Conclusion We can conclude that patient - controlled - intravenous - analgesia （PCIA） with butorphanol for postoperative analgesia is satisfactory and safe and relief with fewer side effects.