酒石酸布托啡諾預防全麻腹腔鏡膽囊切除患者術后寒戰的臨床觀察

[摘要] 目的 探討酒石酸布托啡諾預處理后對全麻恢復期寒戰的療效和不良反應。方法 60例擇期手術的男性患者，ASAI-II級，隨機分為三組，每組20例。B組注入布托啡諾1mg，P組注入哌替啶50mg，C組注入生理鹽水。術中監測血壓、心率、體溫，術后5、30、60min分別對寒戰、疼痛進行評估，并觀察不良反應的發生情況。結果 ①P組蘇醒時間顯著延長(P<0.05)，B組與C組比較蘇醒時間無明顯差別(P>0.05);②B組術中體溫降低幅度明顯小于P組與C組，P組與C組相比體溫降低幅度無明顯差別(P>0.05);③B組與P組術后寒戰發生率明顯小于C組(P<0.05)，B組和P組之間無明顯差別(P>0.05)。結論 酒石酸布托啡諾能顯著減輕全麻術后寒戰，且不會延遲蘇醒。

[關鍵詞] 酒石酸布托啡諾;哌替啶;全麻;寒戰

[中圖分類號] R971+.2[文獻標識碼] A[文章編號] 1004-8650(2009)09-04-03

The effect of butorphanol preconditioning prevent of shivering of patients after laparoscopic cholecystectomy with general anesthesia

DING Meng-yao， ZHAO Zhi-bing

(Department of anesthesiology， the first people?s hospital of Lianyungang，222000)

[Abstract] Objective To investigate the curative effect and untoward reaction of butorphnol preconditioning to prevent shivering after laparoscopic cholecystectomy with general anesthesia.Methods Sixty male patients under laparoscopic cholecystetomy with ASAⅠ-Ⅱ class were randomly divided into B group， P group and C group. Conventional induction and maintenance of general anesthesia， after operation and before wake， butorphnol intravenous with 1mg in B group， pethidine with 50mg in P group and saline with 1ml in C group. Signs and parameters such as body temperature were monitored during the operation， time of recovery was recorded， manifestations of shivering and analgesia were evaluated 5， 30 and 60 min after the entrance of PACU， and the side effects were observed. Results Compared with other groups ， time of recovery was significantly longer in pethidine group. The variation of body temperature was significantly less in B group than that in other groups. The incidence of postoperative shivering was much lower in B group and P group than that in C group， while there was no significant difference between B group and P group. There was no severe side effects were observed. Conclusion Pretreatment with butorphanol is effective in preventing postoperative shivering and the time of recovery wasn't prolonged.

[Key Words] butorphanol;pethidine;general anesthesia;shivering

大手術后出現寒戰十分常見，全麻病人恢復期發生率為3.5%-70.0%[1，2]，寒戰會增加代謝率達400%[3]。臨床通常用哌替啶預防和治療寒戰，雖然效果確切，但其對呼吸循環功能有不同程度的抑制。布托啡諾是一種阿片類中樞鎮痛鎮靜藥，不良反應少，也可以用來治療椎管內麻醉后寒戰[4]，但其關于全麻術后寒戰的治療效果尚無報道。本文旨在觀察布托啡諾預處理對全麻恢復期寒戰的療效。

1資料和方法

1.1一般資料

選擇普外科腹腔鏡膽囊切除手術的男性患者60例。年齡30-45歲，體重50-70kg，ASAI-II級，均無發熱、代謝性疾病及大面積皮膚燒傷，無β受體阻滯劑、氯丙嗪、異丙嗪、三環類抗抑郁藥等服藥史;無嚴重心、肺、肝、腎功能不全、內分泌失調及神經肌肉傳導疾患。……