CAJ | 학술논문

目的：观察布托啡诺用于恶性肿瘤盆腹腔术后病人自控静脉镇痛（patient controlled intravenous analgesia， PCIA）的疗效及毒副反应发生情况。方法240例行盆腔和腹腔恶性肿瘤根治性手术患者，随机分为布托啡诺组（A组）和吗啡组（B组），其中A组分为A1~A6组6个亚组；B组分为B1组、B2组2个亚组，每个亚组30例。术后，A1~A6组患者分别予以1.6μg/（kg·h）、2.0μg/（kg·h）、2.4μg/（kg·h）、2.8μg/（kg·h）、3.2μg/（kg·h）和3.6μg/（kg·h）6个不同剂量的布托啡诺行PCIA治疗；B1组患者选用吗啡行PCIA，B2组则肌注吗啡镇痛。术后24 h观察患者视觉模拟评分（visual analogue scale，VAS）、舒适度评分（bruggrmann comfort scale，BCS）及Ramsay镇静评分以评估PCIA的镇痛和镇静效果，并且记录恶心呕吐、眩晕等阿片类药物毒副反应发生率。结果 A1组、A2组患者的VAS分别为5.58±0.94、5.22±0.86，均较B1组（2.88±1.59）高（P均<0.05），而BCS分别为1.92±0.92、1.79±0.79，均较B1组（2.32±1.13）低（P均<0.05）；A3~A6组、B1组患者的VAS均较B2组低（P均<0.05），而BCS则比B2组高（P均<0.05）；A5组、A6组患者的Ramsay镇静评分为3.33±1.28、4.13±1.21，均较其他亚组高（P均<0.05）。A1~A6组患者的恶心呕吐、腹胀的发生率低于B1组（P均<0.05）；A1组、A2组、A3组患者眩晕的发生率明显低于其他组（P均<0.05）；A1组、A2组患者镇痛不全的发生率高于A3~A6组及B1组（P均<0.05）。结论布托啡诺用于盆腹腔恶性肿瘤术后PCIA的镇痛疗效满意，且镇静过度、恶心呕吐、腹胀等毒副反应较吗啡少。
목적：관찰포탁배낙용우악성종류분복강술후병인자공정맥진통（patient controlled intravenous analgesia， PCIA）적료효급독부반응발생정황。방법240례행분강화복강악성종류근치성수술환자，수궤분위포탁배낙조（A조）화마배조（B조），기중A조분위A1~A6조6개아조；B조분위B1조、B2조2개아조，매개아조30례。술후，A1~A6조환자분별여이1.6μg/（kg·h）、2.0μg/（kg·h）、2.4μg/（kg·h）、2.8μg/（kg·h）、3.2μg/（kg·h）화3.6μg/（kg·h）6개불동제량적포탁배낙행PCIA치료；B1조환자선용마배행PCIA，B2조칙기주마배진통。술후24 h관찰환자시각모의평분（visual analogue scale，VAS）、서괄도평분（bruggrmann comfort scale，BCS）급Ramsay진정평분이평고PCIA적진통화진정효과，병차기록악심구토、현훈등아편류약물독부반응발생솔。결과 A1조、A2조환자적VAS분별위5.58±0.94、5.22±0.86，균교B1조（2.88±1.59）고（P균<0.05），이BCS분별위1.92±0.92、1.79±0.79，균교B1조（2.32±1.13）저（P균<0.05）；A3~A6조、B1조환자적VAS균교B2조저（P균<0.05），이BCS칙비B2조고（P균<0.05）；A5조、A6조환자적Ramsay진정평분위3.33±1.28、4.13±1.21，균교기타아조고（P균<0.05）。A1~A6조환자적악심구토、복창적발생솔저우B1조（P균<0.05）；A1조、A2조、A3조환자현훈적발생솔명현저우기타조（P균<0.05）；A1조、A2조환자진통불전적발생솔고우A3~A6조급B1조（P균<0.05）。결론포탁배낙용우분복강악성종류술후PCIA적진통료효만의，차진정과도、악심구토、복창등독부반응교마배소。
Objective To examine the therapeutic efficacy and adverse events associated with butorphanol during postoperative patient-controlled intravenous analgesia (PCIA). Methods A total of 240 patients treated by radical surgery to remove malignant tumors in the lymph node basin and abdomen were randomized into 8 groups of 30 patients each. Groups A1-A6 performed PCIA with different doses of butorphanol [(1.6,2.0,2.4,2.8,3.2 and 3.6 μg/(kg·h)]. Group B1 performed PCIA with morphine,while group B2 received intramuscula r injections of morphine. At 24 h after analgesia,self-reported pain assessments were made using the Visual Analogue Scale(VAS),Bruggmann Comfort Scale(BCS)and Ramsay score. Side effects of PCIA were assessed at the same time. Results Groups A1 and A2 had significantly higher VAS scores (5.58±0.94 and 5.22±0.86)than group B2 (P<0.05)and significantly lower BCS scores (1.92±0.92 and 1.79±0.79;P<0.05). Conversely,groups A3-A6 and group B1 had lower VAS scores and higher BCS scores than group B2. Ramsay scores were highest in groups A5(3.33±1.28)and A6(4.13±1.21). Nausea,vomiting,and abdominal distension occurred to a much lower extent in in groups A1-A3 than in the other groups. Incomplete analgesia occurred to a much lower extent in groups A3-A6 and B1 than in groups A1-A2. Conclusion Butorphanol shows satisfactory analgesic efficacy in PCIA and is associated with lower incidence of adverse reactions (sedation, nausea, vomiting, abdominal distension) than morphine.