【摘要】 比較布托啡諾與芬太尼用于短時(shí)手術(shù)全麻中的臨床效果及不良反應(yīng)，評(píng)價(jià)布托啡諾用于全麻的臨床作用及安全性。方法 ASAⅠ～Ⅱ級(jí)耳鼻咽喉科擇期聲帶息肉摘除術(shù)住院患者40例，手術(shù)時(shí)間（12±2）min，隨機(jī)分為布托啡諾組（B組，n=20）和芬太尼組(F組，n=20)。B組誘導(dǎo)靜脈注射布托啡諾20 μg·kg-1，F(xiàn)組誘導(dǎo)靜脈注射芬太尼5 μg·kg-1，2組4 min后均靜脈注射丙泊酚及琥珀膽堿行氣管插管控制呼吸，術(shù)中靜脈輸注丙泊酚、瑞芬太尼及琥珀膽堿維持麻醉。術(shù)中監(jiān)測(cè)平均動(dòng)脈壓（MAP）、心率（HR）、脈搏血氧飽和度（SpO2）、呼吸頻率（RR）、術(shù)后Ramsay鎮(zhèn)靜評(píng)分及VAS鎮(zhèn)痛評(píng)分、不良反應(yīng)和拔管時(shí)間。結(jié)果 ①與術(shù)前相比，B組靜脈注射布托啡諾后及術(shù)后RR、SpO2無(wú)明顯變化(P>0.05)；F組靜脈注射芬太尼后及術(shù)后RR下降顯著(P<0.05)，術(shù)后拔管時(shí)間明顯大于B組(P<0.05)。②B組各時(shí)間點(diǎn)MAP、HR變化不明顯(P>0.05)；F組靜脈注射芬太尼后HR下降顯著(P<0.05)。③拔管后B組VAS評(píng)分明顯低于F組(P<0.05)。④F組嗆咳、惡心、肌肉僵直、寒顫、呼吸抑制等不良反應(yīng)發(fā)生率明顯高于B組(P<0.05)。結(jié)論 靜脈注射20 μg·kg-1布托啡諾可安全用于短時(shí)手術(shù)全身麻醉，不良反應(yīng)發(fā)生率低。 【關(guān)鍵詞】 布托啡諾 全身麻醉 短時(shí)手術(shù) 芬太尼 Abstact: Objective To evaluate the clinical effect and safety of butorphanol induced general anesthesia in short-time operation against the fentanyl induced one. Methods Forty patients， with ASA grades Ⅰ and Ⅱ， diagnosed to have polyp of vocal cord for extirpation， were randomly pided into 2 groups of 20 each: butorphanol group (group B) and fentanyl group (group F). Anesthesia was induced with butorphanol (20 μg·kg-1) in group B and with fentanyl (5μg·kg-1) in group F. Four min later， intravenous propofol (2 mg·kg-1 ) and anectine (1.5 mg·kg-1 ) were given to intubate the trachea and start mechanical ventilation. The anesthesia was then maintained with intravenous propofol， remifentanil and anectine during the operation. The heart rate (HR)， mean arterial blood pressure (MAP)， respiratory rate (RR)， saturation of pulse oxygen (SpO2) and adverse effects were noticed before and during the operation and after the extubation. The quality of analgesia and sedation was scored after extubation， with the time of extubation put down. Results There were no significant changes in RR and SpO2 in group B after the intravenous butorphanol and the operation (P>0.05). But the RR dropped significantly in group F after intravenous fentanyl and the operation (P<0.05)， so the time of extubation had to be postponed. The MAP and HR were not altered in group B， but the HR dropped markedly in group F (P<0.05). The VAS value after extubation was significantly lower in group B than in group F (P<0.05). The adverse gagging， bucking， shivering and respiratory depression were significantly less marked in group B than in group F (P<0.05). Conclusion It is safe and feasible to use butorphanol (20 μg·kg-1) to perform general anesthesia for short-time operation， with lower incidence of side effects. Key words: butorphanol; gerneral anesthesia; short-time operation; fentanyl 阿片類鎮(zhèn)痛藥芬太尼具有鎮(zhèn)痛作用強(qiáng)和循環(huán)影響小的特點(diǎn)而廣泛用于全身麻醉，但其呼吸抑制作用時(shí)間長(zhǎng)而常致拔管延遲，不適于短時(shí)手術(shù)全身麻醉。布托啡諾為阿片類受體激動(dòng)-拮抗劑，鎮(zhèn)痛效應(yīng)強(qiáng)，不良反應(yīng)發(fā)生率低，廣泛應(yīng)用于術(shù)后鎮(zhèn)痛。布托啡諾可否安全應(yīng)用于全身麻醉，特別是短時(shí)手術(shù)全身麻醉，國(guó)內(nèi)外少有文獻(xiàn)報(bào)道。本研究比較了布托啡諾、芬太尼用于短時(shí)手術(shù)全身麻醉對(duì)呼吸、循環(huán)的影響，鎮(zhèn)痛效果及不良反應(yīng)。 1 資料和方法 1.1 一般資料 40例聲帶息肉摘除手術(shù)住院患者，ASAⅠ～Ⅱ級(jí)，年齡40～56歲，體重55～69 kg，隨機(jī)分為芬太尼組（F組，n=20）和布托啡諾組（B組，n=20）?；颊咝g(shù)前無(wú)心肺疾病及高血壓病史，肝、腎功能無(wú)明顯異常。2組患者的年齡、體重、手術(shù)時(shí)間差異均無(wú)顯著性。見(jiàn)表1。表1 2組患者的年齡、體重、手術(shù)時(shí)間 1.2 方法 2組患者術(shù)前30 min肌注東莨菪堿0.3 mg，入室后開(kāi)放上肢靜脈。B組患者靜脈注射布托啡諾20 μg·kg-1，F(xiàn)組患者靜脈注射芬太尼5 μg·kg-1。2組患者用藥后4 min靜脈注射丙泊酚2 mg·kg-1，琥珀膽堿1.5 mg·kg-1，面罩加壓供氧，肌松完全后行氣管插管接呼吸機(jī)控制呼吸。術(shù)中靜脈輸注丙泊酚3～4 mg·kg-1 ·h-1，瑞芬太尼0.3μg·kg-1·min-1及琥珀膽堿維持麻醉。采用Datex心電檢測(cè)儀常規(guī)對(duì)呼吸、循環(huán)進(jìn)行監(jiān)測(cè)。手術(shù)結(jié)束后停止輸注丙泊酚、瑞芬太尼和琥珀膽堿。 1.3 觀察指標(biāo) ①記錄術(shù)前（T0）、靜脈注射布托啡諾或芬太尼后4 min（T1）、插管后即刻（T2）、手術(shù)開(kāi)始（T3）、拔管前5 min（T4）及拔管后30 min（T5）的心率（HR）、平均動(dòng)脈壓（MAP）、呼吸頻率（RR）、脈搏血氧飽和度（SpO2）及不良反應(yīng)。②記錄術(shù)后拔管時(shí)間（手術(shù)結(jié)束到拔除氣管導(dǎo)管時(shí)間）。③觀察患者拔管后鎮(zhèn)痛、鎮(zhèn)靜評(píng)分。鎮(zhèn)痛評(píng)分采用視覺(jué)模擬評(píng)分(VAS）：0分為無(wú)痛，10分為劇痛。鎮(zhèn)靜評(píng)分采用Ramsay法:1分為焦慮狀態(tài)；2分為平靜合作；3分為稍沉默，有定向力；4分為睡眠，對(duì)呼喊反應(yīng)敏感；5分為睡眠，對(duì)呼喊反應(yīng)遲鈍。不良反應(yīng)包括嗆咳、惡心、嘔吐、肌肉僵直、寒顫、呼吸抑制等。 1.4 統(tǒng)計(jì)學(xué)處理 所得數(shù)據(jù)均采用SSPS 13.0軟件進(jìn)行統(tǒng)計(jì)分析。定量資料以±s表示，采用t檢驗(yàn)；定性資料采用χ2檢驗(yàn)。P＜0.05認(rèn)為差異有顯著性。 2 結(jié) 果 2.1 呼吸、循環(huán)功能變化 與術(shù)前比較，2組患者插管后及拔管后MAP、HR有所升高，但差異無(wú)顯著性（P＞0.05）；F組靜脈注射芬太尼后HR下降明顯(P＜0.05）；F組患者靜脈注射芬太尼后及術(shù)后RR明顯低于B組(P＜0.05），而SpO2差異無(wú)顯著性（P＞0.05）。見(jiàn)表2。表2 2組患者HR、MAP、RR、SpO2的變化與給藥前比較：*P<0.05；與B組同時(shí)點(diǎn)比較:#P<0.05

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