布托啡诺超前镇痛在瑞芬太尼麻醉腹腔镜胆囊切除术中的应用

目的评价布托啡诺超前镇痛对瑞芬太尼麻醉下胆囊切除术的镇痛效果。方法选择40例腹腔镜下胆囊切除术患者，ASAⅠ～Ⅱ级。随机分为2组（n=20），布托啡诺超前镇痛组（I组）：麻醉前静脉注射布托啡诺30μg／kg超前镇痛；对照组：麻醉前静脉注射生理盐水。在手术结束后0．5、2,4、8、16、24h测定VAS评分（视觉模拟评分），观察镇痛效果；同时记录术中瑞芬太尼用量、拔管时间、拔管后清醒评分及术后嗜睡、恶心、呕吐、瘙痒等不良反应发生率。结果术后VAS评分及术中瑞芬太尼用量I组〈Ⅱ组（P〈0．05）；拔管时间及拔管后清醒评分Ⅰ组〉Ⅱ组但无统计学意义（P〉0．05）；两组术后不良反应发生率均较低。结论布托啡诺超前镇痛能够弥补瑞芬太尼麻醉腹腔镜手术术后镇痛不足的缺点，安全有效，值得临床采用。

Application of butorphanol preemptive analgesia in laparoscopic cholecystectomy with remifentanil anaesthesia

Objective To evaluate the analgesic activities of tartaric acid butorphanol preemptive analgesia to cholecystcctomy with remifentanil anaesthesia. Methods 40 cases of cholecystectomy patients under lapamscopy （ASA Ⅰ -Ⅱ ） are selected, and divided into two groups （n = 20） randomly： butorphanol preemptive analgesia group （Group Ⅰ） ： butorphanol 30μg/kg preemptive analgesia is added by intravenous injection before anaesthesia; control group （Group Ⅱ） ： normal saline is added by intravenous injection before anaesthesia. After the operation, measure VAS score after 0. 5, 2, 4, 8, 16, 24h, and observe the analgesic activities. Meanwhile, record the remifentanil dosage, extubation time, lucidity score after extubation during the operation and the incidence of untoward effect after the operation, such as lethargy, nausea, vomition, itching etc. Results For VAS score after the operation and remifentanil dosage during the operation, Group Ⅰ is lower than Group Ⅱ （ P 〈 0. 05 ）. For extubation time and lucidity score after extubation, Group Ⅰ is higher than Group If. However, there is no statistical significance （ P 〉 0.05 ）. For both groups, the incidence of untoward effect after the operation is low. Except lethargy, there is no no statistical significance. Conclusion Butorphanol preemptive analgesia can remedy the disadvantage of insufficient analgesia after the laparoscopy operation with remifentanil anaesthesia. It is safe and effective, therefore it worthy to be used clinically.