不同剂量布托啡诺经鼻给药超前镇痛对老年患者苏醒期术后寒战发病率的影响

Effect of different dosages of Butorphanol preemptive analgesia by nasal administration on incidence of postoperative shivering during recovery period in senile patients

摘要:

目的 观察不同剂量布托啡诺经鼻给药超前镇痛对行胃、结肠癌根治术的老年患者苏醒期术后寒战发病率的影响。方法 选择全身麻醉下行胃、结肠癌根治术的老年患者360 例，采用随机数字表法，将其分为5 组：布托啡诺0.005 mg/kg 组（B1 组）、布托啡诺0.010 mg/kg 组（B2 组）、布托啡诺0.02 mg/kg 组（B3 组）及布托啡诺0.030 mg/kg 组（B4 组）及对照组（C 组）。B1、B2、B3 及B4 组于麻醉诱导前10 min分别按照各自剂量经鼻给予布托啡诺；C 组以等容量生理盐水替代。统计手术时间、麻醉苏醒时间、拔管时间、在PACU 内停留时间、术中舒芬太尼和丙泊酚的用量及苏醒期恶心呕吐、喉痉挛、呼吸抑制等不良反应的发病率，并进行苏醒期术后寒战评级及拔管后5 min 口述镇痛评分。结果 与B1 及C 组比较，B2、B3 及B4 组舒芬太尼用量明显减少，苏醒期恶心呕吐、呼吸抑制及喉痉挛的发病率、术后寒战评级及拔管5 min 口述镇痛评分降低（P <0.05）；与B1、B4 及C 组比较，B2 及B3 组的麻醉苏醒时间、拔管时间、在PACU 内停留时间缩短（P <0.05）。结论 布托啡诺0.010 ～ 0.020 mg/kg 经鼻给药超前镇痛可降低行胃、结肠癌根治术的老年患者苏醒期术后寒战的发病率，且术后恶心、呕吐等其他并发症明显减少，无苏醒延迟。

Abstract:

Objective To evaluate the effect of different dosages of Butorphanol preemptive analgesia by nasal administration on the incidence of postoperative shivering during recovery period in senile patients with radical gastrectomy or radical resection of colon carcinoma. Methods Totally 360 elderly patients selected for radical gastrectomy or radical resection of colon carcinoma under general anesthesia were randomly divided into five groups utilizing random number table (72 in each group): group B1 (0.005 mg/kg of Butorphanol), group B2 (0.010 mg/kg of Butorphanol), group B3 (0.020 mg/kg of Butorphanol), group B4 (0.030 mg/kg of Butorphanol) and group C (equal volume of physiological saline, control group). At 10 min before induction of anesthesia, the patients in the groups B1, B2, B3 and B4 received corresponding amount of Butorphanol by nasal administration. The patients in the group C received the same volume of normal saline. The operation time, recovery time after anesthesia, extubation time and residence time in PACU, amount of Sulfentanyl and Propofol during operation and incidences of nausea and vomiting,laryngeal spasm and respiratory depression were observed and recorded; and the postoperative shivering rating during recovery period and oral analgesia scores 5 min after extubation were assessed. Results Compared with the groups B1 and C, the amount of Sulfentanyl was decreasd obviously, and the incidences of nausea and vomiting, respiratory depression and laryngeal spasm during postoperative recovery period, and postoperative shivering rating during recovery period and oral analgesia scores 5 min after extubation were reduced significantly in the groups B2, B3 and B4 (P < 0.05). Compared with the groups B1, B4 and C, the recovery time after anesthesia, extubation time and residence time in PACU were shortened obviously in the groups B2 and B3 (P < 0.05). Conclusions Butorphanol preemptive analgesia by nasal administration with injection amount of 0.010-0.020 mg/kg can reduce the incidence of postoperative shivering during recovery period in senile patients with radical gastrectomy or radical resection of colon carcinoma, moreover, nausea and vomiting and some other complications are also significantly reduced, furthmore,there is no delayed recovery.