布托啡诺不同给药方式联合右美托咪定静脉泵注在老年腹腔镜胆囊切除术超前镇痛中的应用

Application of different administration methods of butorphanol combined with intravenous infusion of dexmedetomidine for preemptive analgesia in elderly patients undergoing laparoscopic cholecystectomy

中文关键词: 老年  腹腔镜胆囊切除术  布托啡诺  右美托咪定  超前镇痛  静脉注射  鼻喷

英文关键词: elderly  laparoscopic cholecystectomy  butorphanol  dexmedetomidine  preemptive analgesia  intravenous injection  nasal spray

中文摘要:

      目的 探讨布托啡诺不同给药方式联合右美托咪定(DEX)静脉泵注在老年腹腔镜胆囊切除术(LC)超前镇痛中的应用价值.方法 选取本院于2021年6月—2024年6月收治的153例行LC的老年患者作为研究对象.采用计算机生成随机数列表法分对照组(n=51)、静脉给药组(n=51)、鼻喷给药组(n=51).静脉给药组LC超前镇痛采用0.5 mg布托啡诺于麻醉诱导前行静脉注射联合应用1 μg/kg DEX行静脉泵注,鼻喷给药组LC超前镇痛采用0.5 mg布托啡诺于麻醉诱导前经鼻喷给药联合应用1 μg/kg DEX行静脉泵注,对照组LC超前镇痛采用生理盐水等体积静脉注射联合应用1 μg/kg DEX行静脉泵注.比较3组超前镇痛前(T0)、插管时(T1)、建立气腹时(T2)和拔管操作时(T3)的体征指标[心率(HR)、动脉压均值(MAP)、血氧饱和度(SpO2)],术后麻醉恢复指标,麻醉苏醒时疼痛情况,LC后补救镇痛情况及不良反应发生情况.结果 静脉给药组与鼻喷给药组老年LC患者T1、T2和T3时间点HR、MAP均低于对照组,T,时间点SpO2低于对照组,拔管时间短于对照组,苏醒时VAS评分低于对照组,补救镇痛数少于对照组,不良反应(排除头晕)发生率均较对照组低(P＜0.05),静脉给药组与鼻喷给药组T1、T2和T3时间点HR、MAP,拔管时间,苏醒时VAS评分,补救镇痛数,不良反应(排除头晕)发生率比较差异无统计学意义(P＞0.05);静脉给药组头晕发生率高于鼻喷给药组(P＜0.05).结论 布托啡诺静脉给药和鼻喷给药联合DEX静脉泵注在老年LC超前镇痛中均表现出良好的疗效,能够有效维持术中患者体征平稳,并显著减轻术后疼痛,且具有较好的安全性.与静脉给药相比,布托啡诺鼻喷给药联合DEX静脉泵注在改善术后某些不良反应方面具有一定的优势.

英文摘要:

      Objective To investigate the application value of different administration methods of butorphanol combined with intravenous infusion of dexmedetomidine(DEX)in preemptive analgesia in elderly patients undergoing laparoscopic chol-ecystectomy(LC).Methods 153 elderly patients undergoing LC in Jiaozhou Central Hospital from June 2021 to June 2024 were selected as the study subjects.They were divided into control group(n=51),intravenous administration group(n=51)and nasal spray administration group(n=51)by computer-generated random number list method.In the intravenous adminis-tration group,LC preemptive analgesia was performed by intravenous injection of 0.5 mg butorphanol before anesthesia induc-tion combined with intravenous pump injection of 1 μg/kg DEX.In the nasal spray administration group,LC preemptive anal-gesia was performed by nasal spray of 0.5 mg butorphanol before anesthesia induction combined with intravenous pump injec-tion of 1 μg/kg DEX.In the control group,LC preemptive analgesia was performed by intravenous injection of equal volume of normal saline combined with intravenous pump injection of 1 μg/kg DEX.The vital signs[heart rate(HR),mean arterial pressure(MAP)and oxygen saturation(SpO2)]at pre-analgesia(T0),intubation(T,),pneumoperitoneum establishment(T2),and extubation(T3),and postoperative anesthesia recovery indicators,pain degree during anesthesia recovery,remedial analgesia after LC and the incidence of adverse reactions were compared among the three groups.Results Compared with the control group,the HR and MAP at T,,T2 and T3 in the intravenous administration group and nasal spray administration group were lower,SpO2 at T,was lower,extubation time was shorter,VAS score at awakening was lower,number of cases with re-medial analgesia after LC was smaller,and the incidence of adverse reactions(excluding dizziness)were lower(all P＜0.05).The incidence of dizziness in the intravenous administration group was higher than that in the nasal spray administration group(P＜0.05).Conclusion Butorphanol intravenous administration and nasal spray administration combined with DEX in-travenous pump injection have shown good efficacy in preemptive analgesia for elderly LC patients.They can effectively main-tain the stability of intraoperative vital signs of patients,and significantly reduce postoperative pain,and have a good safety.Compared with intravenous administration,butorphanol nasal spray combined with DEX intravenous pump injection has certain advantages in improving some postoperative adverse reactions.