布托啡诺与芬太尼对瑞芬太尼麻醉后早期痛觉过敏的治疗效果比较

目的比较布托啡诺与芬太尼对瑞芬太尼麻醉术后早期痛觉过敏（OIH）的防治作用。方法选取ASAI-II级,年龄18～45岁的择期手术患者50例,随机分成两组：布托啡诺（B组）,芬太尼（F组）,每组25例。两组皆采用吸入0.7～1.3MAC七氟醚＋0.05～0.25ug.kg-1.min-1瑞芬太尼维持麻醉,进行心电图、无创血压、SpO2、BIS、TOF、ETCO2、麻醉气体浓度监测。观察指标：（1）拔管期指标：记录静注芬太尼或布托啡诺前基础值（T0）、静脉注射芬太尼或布托啡诺后5min（T1）、拔管前（T2）、拔管后1min（T3）、插管后5min（T4）的HR、MAP、SpO2、BIS值。（2）拔管后30min、1h、4h早期镇静/警觉（OAA/S）与镇痛（VAS）评分。（3）PACU不良反应。结果两组各时点的HR、MAP、SpO2的差异均无统计学意义（P〉0.05）,而B组在T1的BIS明显低于F组（P〈0.05）。OAA/S在拔管后30min与1h两时间点,B组与F组差异有统计学意义（P〈0.05）,在各时间点B组VAS均明显低于F组（P〈0.05）。术后不良反应无统计学意义（P〉0.05）。结论在腔镜手术结束时静脉注射布托啡诺对瑞芬太尼麻醉后早期痛觉过敏的防治效果优于芬太尼。

A Contrast Study of the Effect of Butorphanol and That of Fentanyl on Hyperalgesia after the Anesthesia with Remifentanil

Objective To compare the effect of butorphanol and that of fentanyl on the hyperalgesia after the anesthesia of remifentanil.Methods 50 cases（ASAI~II） of selective operation,aged from 18 to 45 years old,were randomly divided into 2 groups： butorphanol group and fentanyl group,25 cases in each;0.7~1.3MAC sevoflurane ＋ 0.05~0.25ug·kg-1·min-1 remifentanil for anesthesia maintenance were applied to patients in both groups,and ECG,noninvasive blood pressure（NIBP）,SpO2,BIS,TOF,ETCO2 and anesthesia gas concentration were monitored;observation was made to the following data：（1） the data during the tracheal extubation： the basic data before the intravenous injection of fentanyl or butorphanol（T0）,the data of HR,MAP and BIS 5 minutes after the intravenous injection of fentanyl or butorphanol（T1）,the data before tracheal extubation（T2）,the data 1 minute after tracheal extubation（T3） and the data 5 minutes after intubation（T4）;（2） the data of OAA/S at each time point of 30 minutes,1 hour and 4 hours after tracheal extubation as well as the scores of VAS;（3） the side effect of PACU.Results The difference in HR,MAP and SpO2 at different time points between the 2 groups was of no statistical significance（P〈0.05）;BIS of T1 in butorphanol group was obviously lower than that in fentanyl group（P〈0.05）;OAA/S at the time points of 30 minutes and 1 hour after tracheal extubation in the 2 groups were statistically different from each other（P〈0.05）;VAS of butorphanol group at each time point were obviously lower than those in fentanyl group（P〈0.05）;the statistical study of the post-operative side effects was of no significance（P〈0.05）.Conclusions Butorphanol is of better effect on hyperalgesia after the anesthesia of remifentanil than fentanyl.