丙帕他莫与布托啡诺超前镇痛辅助臂丛麻醉效果的比较(1)
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[摘要] 目的 观察盐酸丙帕他莫、酒石酸布托啡诺、盐酸哌替啶术前超前镇痛辅助手部显微外科手术臂丛麻醉的效果。 方法 选择ASA Ⅰ～Ⅱ级手外科手术患者120例，将其随机分为三组，每组各40例。所有患者都采用神经刺激器辅助定位下行臂丛神经阻滞，使用药物0.5%罗哌卡因30 mL。麻醉前15 min Ⅰ组静脉注射酒石酸布托啡诺1 mg，Ⅱ组注射盐酸丙帕他莫2 mg，Ⅲ组静脉注射盐酸哌替啶50 mg，手术开始前再次重复上述操作。观察记录患者麻醉起效时间、麻醉维持时间、麻醉效果和术中、术毕、术后4 h的VAS评分和镇静评分及不良反应的发生情况。 结果 Ⅰ、Ⅱ组麻醉维持时间显著长于Ⅲ组(P < 0.05)；Ⅰ组术中、术毕、术后4 h 的VAS评分<3分者明显高于Ⅱ、Ⅲ组(P < 0.05)；Ⅰ组不良反应的发生例数明显低于Ⅱ、Ⅲ组(P < 0.05)。 结论 手部显微外科手术臂丛麻醉辅助使用酒石酸布托啡诺行超前镇痛能够增强臂丛麻醉的麻醉效果，镇痛、镇静效果明显，延长术后镇痛时间，不良反应发生率低，值得临床推广使用。
[关键词] 显微外科；超前镇痛；盐酸丙帕他莫；酒石酸布托啡诺
[中图分类号] R641 [文献标识码] A [文章编号] 1673-7210(2012)01(b)-096-03
Comparison of Propacetamol and Butorphanol′s effects in preemptive analgesia for brachial plexus
CHEN Xiaodong SUN Xiaochong HUA Hao DING Haozhong
Department of Anesthesiology, the Ninth People′s Hospital of Wuxi City Hand Surgery Hospital of Wuxi City, Jiangsu Province, Wuxi 214062, China
[Abstract] Objective To observe the effects of Propacetamol, Butorphanol and Pethidine Hydrochloride in preemptive analgesia for hand microsurgeries to brachial plexus. Methods 120 patients (ASA Ⅰ-Ⅱ) were randomly divided into 3 groups, with 40 cases in each group. Neuro-Stimulator was used to help position the lower brachial plexus′s nerve blocking with the use of 30 mL 0.5% Ropivacaine. 1 mg Butorphanol were injected to group Ⅰ, 2 mg Propacetamol to group Ⅱ, and 50 mg Pethidine Hydrochloride to group Ⅲ 15 minutes before anesthesia, then the above procedure were repeated before the surgery. The duration as well as the effects of the anesthesia, the VAS scores during the surgery, right after the surgery and 4 hours after the surgery, the calmness score and any adverse reaction were recorded. Results The duration of anesthesia of group Ⅰ and Ⅱ was longer than that of group Ⅲ (P < 0.05). The VAS scores < 3 scores during the surgery, right after the surgery, and 4 hours after the surgery of group Ⅰ were all significantly less than those of group Ⅱand Ⅲ (P < 0.05). The patients with adverse reaction in group Ⅰwere less than those of group Ⅱand Ⅲ(P < 0.05). Conclusion Butorphanol used in preemptive analgesia for hand microsurgeries to brachial plexus can significantly enhance anesthesia, prolong the duration of anesthesia with much less adverse reaction, it′s worthy of clinical promotion and application ......
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