布托啡诺与舒芬太尼在肺叶切除术后镇痛效果的比较

目的:比较布托啡诺和舒芬太尼在电视辅助胸腔镜(VATS)下小切口肺叶切除术后患者静脉自控镇痛(PCIA)的效果。方法:择期全麻下行VATS肺叶切除术患者75例(22岁～57岁),ASAⅡ级,随机分成布托啡诺I组(BI组)、布托啡诺II组(BII组)、舒芬太尼组(S组),每组25例。在手术结束前30min,BI、BII组给予布托啡诺负荷量30μg/kg,S组给予舒芬太尼负荷量0.1μg/kg,术毕BI、BII组分别以布托啡诺3μg/kg/h,4μg/kg/h维持PCIA,S组以舒芬太尼0.05μg/kg/h维持PCIA。观察并记录术后1h、6h、12h、18h、24h、36h、48h的平均动脉压、心率、呼吸频率、脉搏氧饱和度、患者平静时的视觉模拟(VAS)疼痛评分及Ramsay镇静评分,术后12h、24h、36h、48h的恶心评级和呕吐评级。并记录患者术后36h和48h咳嗽时的VAS疼痛评分。结果:术后48h内三组患者各观察时点的呼吸循环指标、Ramsay镇静评分、恶心、呕吐评级比较无显著差异。在术后6h～24h各时点,BII组与S组间VAS评分差异无显著性,但BII组和S组VAS评分均低于BI组(P<0.05)。术后36h、48h患者咳嗽时VAS评分,BII组和S组均低于BI组(P<0.05),但BII组与S组间无显著差异。结论:VATS手术结束前30min缓慢静注布托啡诺负荷量30μg/kg,术后给予4μg/kg/h的维持量,与舒芬太尼PCIA同样安全有效。

Patient-controlled Intravenous Analgesia with Butorphanol and Sufentanil after Video Assisted Thoracoscopic Surgery:a Comparative Study

Objective To evaluate the clinical effects of butorphanol and sufentanil for patient-controlled intravenous analgesia （PCIA） after Video assisted thoracoscopic surgery （VATS）. Methods 75 ASA Ⅱ patients （22 to 57 years of age） who underwent VATS lobectomy were randomly divided into butorphanol groupⅠ （group BⅠ）, butorphanol group Ⅱ, （group BⅡ） and sufentanil group（group S）.Intravenous loading dose of butorphanol was 30 μg/kg in group BⅠ and group BⅡ,and that of sufentanil was 0.1 μg/kg in group S 30 min before the end of operation.PCIA maintenance dose of butorphanol in group BI and group BII was 3 μg/kg/h, 4 μg/kg/h,respectively, and that of sufentanil was 0.05 μg/kg/h in group S after operation.Recorded the visual analogue score （VAS）, Ramsay sedative scores, blood pressure, heart rate, respiratory rate, SpO2, at 1 h, 6 h, 12 h, 18 h,24 h, 36 h, and 48 h after administration; incidence of vomiting and nausea at 12 h, 24 h, 36 h, 48 h after administration; VAS when patients coughing 36 h, 48 h after administration.Results There were no significant differences between the three groups about sedative scores, blood pressure, heart rate, respiratory rate, SpO2, and incidence of vomiting and nausea during 48 hs.The VAS was higher in group BI than those in group BII and group S during 6 h-24 h after administration or when patients coughing 36 h, 48 h after administration, but there was no significant difference between group BII and group S（P〈0.05）. Conclusion PCIA with butorphanol provides equal efficacy of analgesia with sufentanil in postoperative patients of VATS.