布托啡诺与奈福泮超前镇痛在乳腺区段切除术的效果比较

目的对比研究酒石酸布托啡诺与盐酸奈福泮超前镇痛在乳腺区段切除术的镇痛效果及不良反应。方法90例择期局麻下乳腺肿块区段切除术患者,随机分为布托啡诺超前镇痛组（B组）、奈福泮超前镇痛组（N组）及安慰剂对照组（C组）,每组患者30例。观察术中MAP、HR、RR和SpO2的变化及疼痛评分（VAS）、Ramsay镇静评分、局麻药用量,围术期恶心、呕吐、头昏、皮肤瘙痒、尿潴留等不良反应。结果B组及N组疼痛评分明显低于对应时间点C组（P〈0.01）,疼痛评分在B组及N组之间比较差异无统计学意义。B组镇静评分明显高于N组及C组（P〈0.01）,镇静评分在N组及C组间比较差异无统计学意义。B组及N组局麻药用量明显少于C组（P〈0.01）。不良反应发生率在3组间比较差异无统计学意义。结论布托啡诺及奈福泮超前镇痛用于乳腺区段切除术都可以明显减轻患者的疼痛,减少局麻药用量,无严重不良反应,但是布托啡诺有明显的镇静作用,可以缓解患者的紧张情绪。

An intravenous bolus injection of butorphanol and nefopam as preemptive analgesia in mastectomy:a comparative study

Objective To compare the clinical efficacy and safety of preemptive analgesia with a bolus of butorphanol and nefopam in a prospective,randomized,double-blind trial.Methods 90 ASA Ⅰ~Ⅱfemale patients scheduled for Segmental mastectomy under local anaesthesia were randomly divided into three groups.Patients in group B received an intravenous bolus injection of 1 mg butorphanol 30min before skin incisions;In group N,20mg nefopam was given;saline in group C.Anesthesia was maintained with 2% lidocaine local infiltration during the procedure.Changes in MAP、HR、RR、SpO2 during operation were observed,the total dosage of local anaesthesic agents was recorded,the estimation of visual analogue scale of pain（VAS）,the sedation score and the side effects were assessed.Results The three groups were comparable with respect to demographic data.There were no difference of MAP、HR、RR、SpO2 between the three groups.The pain scores were lower in group B and N than those in group C（P0.01）.The sedation scores of group B were significantly higher than those in group N and C（P0.01）.The total lidocaine consumption were lower in group B and N than those in group C（P0.01）.No significant difference were observed in the incidences of the adverse effects such as nausea,vomiting and dizziness between the three groups.Conclusion Preemptive analgesia with an intravenous bolus of 1mg butorphanol for segmental mastectomy can significantly alleviate the pain and nervousness of the patients and with lower anesthetic consumption and without seriously side effects.