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布托啡诺与曲马多用于腹腔镜胆囊切除术后气管拔管的比较
作者:钟惠  周斌  尹亚岚  张桂翠  
单位:攀钢总医院麻醉科  解放军532医院麻醉科 
关键词:布托啡诺  曲马多  气管拔管 
分类号:R614
出版年,卷(期):页码:2010,27(1):19-21
摘要:

目的:探讨布托啡诺与曲马多用于腹腔镜胆囊切除(LC)术后气管拔管的安全性及有效性。方法:选择腹腔镜胆囊切除术患者60例,随机分为布托啡诺组(B组)与曲马多组(T组),两组麻醉诱导方式相同。完成插管后,均采用丙泊酚加瑞芬太尼持续静脉泵注,间断推注维库溴铵,各组均于术毕即刻停药,拔腹壁套筒针时分别静注布托啡诺0.03mg/kg或曲马多1.5mg/kg。比较各时点血流动力学参数、血氧饱和度,记录麻醉恢复时间、术后不良反应。对拔管后(5′、15′、30′)行镇静(Ramsay)及舒适(Bcs)评分。结果:与注药前(T0)后(T1)5min相比,拔管即刻(T2)两组MAP、HR有所升高但无差异性(P>0.05),其余各时间点MAP、HR无明显变化。术毕B组自主呼吸恢复、睁眼、拔管时间略长于T组,但无统计学差异(P>0.05)。不良反应:拔管期间B组有1例躁动占3%,T组有4例躁动占14%,组间比较有统计学差异(P<0.05)。Ramsay评分:拔管后B组镇静效果明显高于T组(P<0.05);Bcs评分两组无差异性。结论:布托啡诺能安全、有效地用于LC患者围拔管期的镇痛和镇静,术后不良反应发生率低,患者舒适、满意。

Objective:To investigate the safety and efficacy of Butorphanol and Tramadol used in the tracheal extubation of postoperative laparoscopic cholecystectomy(LC).Methods:60 patients for laparoscopic cholecystectomy were randomly divided into Butorphanol group(B group)and Tramadol group(T group),and used the same method of anesthesia induction between the two groups.After intubation,continuous infusion of propofol with remifentanil and vecuronium was injected intermittently for ,and were stopped immediately after operation.When the sleeve was extracted,the Butorphanol(0.03 mg/kg)and Tramadol(1.5 mg/kg)were injected respectively for the two groups.The parameters of hemodynamics,oxygen saturation,anesthesia recovery time and postoperative side effects were recorded in different points of time.The Sedation score(Ramsay)and comfort score(Bcs)were recorded on post-extubation(5',15',30').Results:MAP and HR of the two groups had the trend of increase at the moment of extubation(T2)but no significant difference(P>0.05)compared with T0(before injection) and T1(5mins after injection).MAP and HR had no significant change at the other time.The time of B group's resumption of spontaneous breathing,eyes open and extubation were longer than T group's,but no significant difference(P>0.05).Adverse reactions:During extubation,there were one patient(3%)of B group and four patients(14%)of T group having restlessness.There was significant difference between the two groups(P<0.05).Ramsay score:After extubation,the sedative efficacy of B group was significantly better than T group (P<0.05);Bcs score of the two groups had no significant difference(P>0.05).Conclusions:The safety and efficacy were affirmatory for analgesia and sedation in period of extubation of LC.There were low incidence of adverse reactions after operation.Patients feel comfortable and satisfactory.

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    [1]. 俞卫锋主编. 麻醉与复苏新论[M]. 第二军医大学出版社 2001
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