吗啡与布托啡诺对腹部手术后患者腹内压的影响

Effect of morphine versus butorphanol on intra-abdominal pressure in patients following gastrointestinal surgery

摘要:

目的 比较吗啡与布托啡诺对胃肠道手术患者腹内压的影响。方法 选取2016年11月至2017年9月期间徐州医科大学附属医院收治的胃肠道开腹手术术后入住ICU的患者80例,按照随机数字表法分为吗啡组和布托啡诺组,每组40例。吗啡组镇痛药为盐酸吗啡 20 mg+生理盐水至40 ml；布托啡诺组镇痛药为酒石酸布托啡诺4 mg+生理盐水至40 ml。2组均以2 ml/h的速度持续泵入,用药时间＞24 h。比较2组患者的临床指标及不同时间点的腹内压水平。采用SPSS 21.0软件进行数据处理。依据数据类型,组间比较分别采用t检验或χ²检验。结果 布托啡诺组在用药后24 h[(13.38±2.03) vs(14.76±3.05)mmHg (1 mmHg=0.133 kPa)]和48 h[(12.33±1.75) vs(14.04±2.70)mmHg]的IAP水平均显著低于吗啡组(P＜0.05)。布托啡诺组患者的胃肠功能恢复时间[(2.65±0.66) vs(3.05±0.67)d]、术后住院时间[(10.08±1.64) vs(12.00±2.56)d]、恶心呕吐发生率(10.00% vs 27.50%)显著低于吗啡组,而嗜睡发生率(25.00% vs 7.50%)显著高于吗啡组,差异均具有统计学意义(P＜0.05)。结论 相较于吗啡,布托啡诺更适合用于胃肠道开放手术患者的镇痛。

Abstract:

Objective To compare the effects of morphine and butorphanol on the intra-abdominal pressure (IAP) in the patients following gastrointestinal surgery. Methods Eighty patients who were admitted to our Intensive Care Unit after gastrointestinal open surgery from November 2016 to September 2017 were prospectively enrolled in this study. They were randomly divided into morphine group (n=40) and butorphanol group (n=40). After operation, the patients from the former group were injected with 20 mg morphine plus normal saline (totally 40 ml) for analgesia, and those from the latter were given 4 mg butorphanol plus normal saline (totally 40 ml), both at a speed of 2 ml/h, for over 24 h. The clinical indices and IAP level at different time points were compared between the 2 groups. SPSS statistics 21.0 was used for statistical analysis, and Student′s t test or Chi-square test was adopted for comparison between groups depending on the types of data. Results The IAP level in the butorphanol group was significantly lower than that in the morphine group at 24 h [(13.38±2.03) vs (14.76±3.05)mmHg, 1 mmHg=0.133 kPa] and 48 h [(12.33±1.75) vs (14.04±2.70)mmHg] after treatment (P<0.05). The patients of the butorphanol group had shorter recovery time of gastrointestinal function [(2.65±0.66) vs (3.05±0.67)d] and length of postoperative hospital stay [(10.08±1.64) vs (12.00±2.56) d], and lower incidence rates of postoperative nausea and vomiting (10.00% vs 27.50%), but higher rate of drowsiness (25.00% vs 7.50%) when compared with those from the morphine group (all P<0.05). Conclusion As analgesic drug, butorphanol may be more suitable than morphine for the patients after gastrointestinal open surgery.