布托啡诺超前镇痛对肺癌患者胸腔镜肺叶切除术围术期应激反应及术后疼痛的影响

目的:研究不同时间点静脉注射布托啡诺对胸腔镜肺叶切除术肺癌患者应激反应、停药苏醒时间、苏醒期躁动、术后疼痛的影响。方法:选取山西医科大学第二医院2019年9月至2020年5月择期行胸腔镜肺叶切除术的肺癌患者90例，按随机数字表法分为三组，每组30例。A组（超前镇痛组）在麻醉诱导前15 min注射布托啡诺20 μg／kg...

Effect of preemptive analgesia with butorphanol on perioperative stress response and postoperative pain in lung cancer patients undergoing thoracoscopic lobectomy

Objective To study the effect of intravenous injection with butorphanol at different time points on stress response,recovery time after drug withdrawal,emergence agitation and postoperative pain in lung cancer patients undergoing thoracoscopic lobectomy.Methods A total of 90 lung cancer patients who underwent elective thoracoscopic lobectomy from September 2019 to May 2020 in the Second Hospital of Shanxi Medical University were selected and randomly divided into three groups according to random number table,30 cases in each group.Group A was set as a preemptive analgesia group,and 20μg/kg butorphanol was injected intravenously at 15 min before anesthesia induction;group B was injected with 20μg/kg butorphanol at 30 min before the end of operation;and the blank control group(group C)was given with the same volume of 0.9%NaCl injection at the same time points.The following data including blood glucose,cortisol,heart rate and mean arterial pressure(MAP),recovery time after skin suture and drug withdrawal,emergence agitation score and incidence rate of restlessness,postoperative pain visual analogue scale(VAS)were observed.Results The level of blood glucose(5.25±0.32),(5.17±0.58)mmol/L]and cortisol(253.63±48.29),(222.17±35.73)ng/ml]in group A were lower than those in group B(5.85±0.53),(5.52±0.48)mmol/L;(302.83±48.63),(274.87±47.93)ng/ml]and group C(6.07±0.70),(5.68±0.52)mmol/L;(319.97±32.05),(295.57±46.83)ng/ml]immediately after skin suture and 6 h after the operation(all P<0.05).There were no significant differences in MAP and heart rate at intubation among the three groups(all P>0.05).The levels of MAP and heart rate in group A at intubation were higher than those before anesthesia induction(all P<0.05);there were no statistical differences of the levels of MAP and heart rate at 30 min after one-lung ventilation and at extubation compared with those before anesthesia induction(all P>0.05).In group B and group C,heart rate and MAP at intubation,30 min after one-lung ventilation and extubation were higher than those before anesthesia induction(all P<0.05).Among them,the recovery time after drug withdrawal in group B(16.53±3.64)min]was longer than that in group A(13.83±3.24)min]and group C(12.47±3.35)min](all P<0.05),while there was no significant difference between group A and group C(P>0.05).In addition,in terms of emergence agitation score and agitation incidence,group A(3.20±0.41)scores,0(0/30)]was lower than group B(3.73±0.74)scores,7%(2/30)]and group C(4.00±0.79)scores,10%(3/30)](all P<0.05).The pain VAS in group A(3.10±0.61)scores,(3.27±0.52)scores]at 3 h and 12 h after operation were lower than those in group B(3.53±0.86)scores,(3.70±0.53)scores]and group C(4.00±0.83)scores,(4.10±0.71)scores]at the same time points(all P<0.05).However,there was no significant difference in pain VAS among the three groups at 24 h and 48 h after operation(all P>0.05).Conclusions For lung cancer patients who underwent thoracoscopic lobectomy,preemptive analgesia with butorphanol not only can reduce the stress response and increase the stability of hemodynamics,but also can effectively reduce the incidence of postoperative pain and restlessness without prolonging the recovery time after stopping drug.