舒芬太尼复合布托啡诺用于开胸手术后静脉镇痛的临床观察

目的：观察舒芬太尼复合布托啡诺的镇痛效果及不良反应,以寻求一种安全有效的开胸术后静脉镇痛配方。方法：将80例行择期开胸手术术后应用静脉自控镇痛治疗的患者,随机分为4组,每组20例。Ⅰ组舒芬太尼150μg,Ⅱ组布托啡诺12mg,Ⅲ组舒芬太尼100μg＋布托啡诺4mg,Ⅳ组舒芬太尼50μg＋布托啡诺8mg。4组分别加生理盐水至100ml。在PCIA开始后4、8、16、24、48h观察并记录镇痛（VAS评分）和镇静（Ramsay评分）效果,并观察不良反应发生情况。结果：Ⅱ组各时点VAS评分和PCA需求次数普遍高于其它3组（P〈0.05）,Ⅰ、Ⅲ、Ⅳ组间比较差异无统计学意义（P〉0.05）。Ⅱ组16h内Ramsay评分显著高于其它3组（P〈0.05）,Ⅰ、Ⅲ、Ⅳ组间比较差异无统计学意义（P〉0.05）。24h后,4组Ramsay评分差异无统计学意义（P〉0.05）。Ⅰ组在8～16h恶心评分和呕吐评分显著高于其它3组（P〈0.05）。结论：舒芬太尼与布托啡诺联合应用是一种理想的术后镇痛方法。

Clinical observation of sufentanil combined with butorphanol for intravenous analgesia after thoracotomy

Objective：To research the effects and adverse reactions of sufentanil combined with butorphanol for intravenous analgesia after thoracotomy and explore a better method for intravenous analgesia administration of sufentanil alone,butorphanol alone or sufentanil combined with butorphanol.Methods：The patients were randomly divided into four groups（twenty cases in each group）.Eighty ASA Ⅰ~Ⅱpatients scheduled for thoracotomy were selected with weight of 46~75 kg and the age of 35~65 years,without drug abusing history（especially opiums）,electrolyte disturbance,allergy to any drugs or history of treating with opiums for chronical pain.GroupⅠ：Sufentanil 150 μg.GroupⅡ：Butorphanol 12 mg.Group Ⅲ：Sufentanil 100 μg＋butorphanol 4 mg.Group Ⅳ：Sufentanil 50 μg＋butorphanol 8 mg.PCIA setting up 2 ml/h and bolus of 0.5 m1 with a lockout-time Interva 15 minutes.The effects of ostoerative analgesia was assessed by recording visual analog scale（VAS）,sedation analog scales,nausea and vomitting scales at 4,8,16,24,48 h,searately after oeration,at the same time monitor zhe heart rate（HR）,SPO2,mean artery pressure（MAP）,breath rate（BR）,the actual controlled times.Results：In the GroupⅡvisual analog scales were significantly higher than those in the GroupⅠ,Group Ⅲ and Group Ⅳ at 4,8,16,24 and 48 h（P0.05）,but there was no difference among GroupⅠ,Group Ⅲ and Group Ⅳ.The total roortion of controlled times in Group Ⅱ was obviously more at 16 h,than that in GroupⅠ,Group Ⅲand Group Ⅳ（P0.05）.Eight patients experienced nausea and four vomited in GroupⅠat 8~16 h,which was significantly more than that in Group Ⅰ,Group Ⅲ and Group Ⅳ（P0.05）.In all four groups,the vital signs were steady,and there was no significant difference.Conclusion：These results suggest that administration of butorphanol combinated with sufentanil is secure and more effective for the thoracotomy.