目的 探討鹽酸丁丙諾啡注射液復合氟哌利多注射液用于胸科術后靜脈自控鎮(zhèn)痛(PCIA)。方法 選取2022年5月-2023年2月在邯鄲市中心醫(yī)院擇期全麻下行胸腔鏡下肺葉切除術的100例患者,所有患者按照計算機隨機數(shù)字表法分為丁丙諾啡組和舒芬太尼組,每組各50例。手術結束前30 min,丁丙諾啡組給予鹽酸丁丙諾啡注射液3 μg/kg,舒芬太尼組給予枸櫞酸舒芬太尼注射液15 μg。術后兩組患者均采用PCIA,丁丙諾啡組:鹽酸丁丙諾啡注射液15 μg/kg+氟哌利多注射液2 mg+0.9%氯化鈉稀釋至150 mL;舒芬太尼組:枸櫞酸舒芬太尼注射液2.5 μg/kg+氟哌利多注射液2 mg+0.9%氯化鈉稀釋至150 mL。比較術畢(T0)、術后2 h(T1)、4 h(T2)、6 h(T3)、12 h(T4)、24 h(T5)、48 h(T6)靜息和咳嗽時的VAS評分。記錄拔出氣管導管時兩組血流動力學波動情況。比較術后24、48 h的QoR-15評分、曲馬多鎮(zhèn)痛補救量、PCIA泵按壓次數(shù)、不良反應發(fā)生情況。結果 兩組術后靜息和咳嗽時2 h(T1)、4 h(T2)、6 h(T3)、12 h(T4)、24 h(T5)、48 h(T6)的VAS評分均低于術畢(T0)(P<0.05)。患者拔出氣管導管時丁丙諾啡組患者的血流動力學波動小于舒芬太尼組(P<0.05)。丁丙諾啡組惡心嘔吐、呼吸抑制發(fā)生例數(shù)少于舒芬太尼組(P<0.05)。結論 鹽酸丁丙諾啡注射液合氟哌利多注射液在胸科圍術期能減輕蘇醒拔管時機體的應激反應,呼吸抑制、惡心嘔吐發(fā)生率低,用于術后鎮(zhèn)痛可達到良好的鎮(zhèn)痛效果和理想的恢復質量。

Objective To investigate the effect on Buprenorphine Hydrochloride Injection combined with Droperidol Injection for patient controlled intravenous analgesia (PCIA) after thoracic surgery. Methods Patients (100 cases) underwent thoracoscopic lobectomy in Handan Central Hospital from May 2022 to February 2023 were divided into buprenorphine group and sufentanil group according to computer random number table method, and each group had 50 cases. 30 Minutes before the end of the surgery, buprenorphine group was administered with Buprenorphine Hydrochloride Injection 3 μg/kg, while sufentanil group was administered with Sufentanil Citrate Injection 15 μg. Both groups received PCIA pump after surgery. Buprenorphine group received Buprenorphine Hydrochloride Injection 15 μg/kg + Droperidol Injection 2 mg/kg + 0.9% sodium chloride to 150 mL. Sufentanil group:Sufentanil Citrate Injection 2.5 μg/kg + Droperidol Injection 2 mg/kg + 0.9% sodium chloride to 150 mL. VAS scores at rest and coughing at postoperative time (T0), 2 h (T1), 4 h (T2), 6 h (T3), 12 h (T4), 24 h (T5), and 48 h (T6) were compared. Hemodynamic fluctuations in two groups during tracheal catheter removal were recorded. QoR-15 scores at 24 and 48 h after surgery, tramadol analgesic relief amount, PCIA pump press frequency, and incidence of adverse reactions were compared. Results The VAS scores at 2 h (T1), 4 h (T2), 6 h (T3), 12 h (T4), 24 h (T5), and 48 h (T6) during postoperative rest and cough in both groups were lower than those after surgery (T0) (P < 0.05). The hemodynamic fluctuations in the buprenorphine group were lower than those in the sufentanil group when the patient removed the tracheal catheter (P < 0.05). The incidence of nausea, vomiting, and respiratory depression in the buprenorphine group was lower than that in the sufentanil group (P < 0.05). Conclusion Buprenorphine Hydrochloride Injection combined with Droperidol Injection can alleviate the stress response of the body during awakening and extubation, with a low incidence of respiratory depression and nausea and vomiting, which can achieve good analgesic effect and ideal recovery quality when used for postoperative analgesia.

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