摘要
目的评价布托啡诺与舒芬太尼镇痛效应的相互作用。方法择期行妇科腹腔镜手术患者90例，ASA分级Ⅰ或Ⅱ级，年龄18～64岁，体重指数〈30 kg/m2，采用随机数字表法，将其分为3组（n＝30）：布托啡诺组（B组）、舒芬太尼组（S组）和布托啡诺混合舒芬太尼组（BS1组）。采用改良序贯法进行试验，B组、S组初始剂量分别0.5 mg、5 μg，剂量调整梯度分别是0.1 mg、1 μg。BS1组按布托啡诺与舒芬太尼的等效剂量2∶1配伍，初始剂量布托啡诺0.25 mg＋舒芬太尼2.5 μg，剂量调整梯度是布托啡诺0.05 mg＋舒芬太尼0.5 μg。给药后15 min内NRS评分≤3分或降低幅度超过50%为镇痛有效。采用概率单位回归分析法计算药物的ED50及95%可信区间（CI）。采用等辐射分析法判断布托啡诺与舒芬太尼镇痛效应的相互作用。根据本研究中B组、S组实际测得的ED50，若发现两药的等效剂量与BS1组参考的等效剂量差别较大时，那么按实际等效剂量1∶1设置BS2组（n＝30）：起始剂量布托啡诺0.4 mg＋舒芬太尼1.8 μg，剂量变化梯度为布托啡诺0.1 mg＋舒芬太尼0.45 μg。结果布托啡诺ED50 0.80 mg（95%CI 0.74～0.87 mg），舒芬太尼ED50 3.68 μg（95%CI 3.07～4.41 μg），BS1组布托啡诺和舒芬太尼ED50分别为0.28 mg（95%CI 0.25～0.32 mg）和2.82 μg（95%CI 2.52～3.16 μg）。BS2组布托啡诺和舒芬太尼ED50分别为0.38 mg（95%CI 0.33～0.43 mg）和1.7 μg（95%CI 1.5～1.9 μg）。等辐射分析法显示两药以2∶1或1∶1复合应用时镇痛效应均为相加作用。结论按2∶1和1∶1等效剂量配伍时布托啡诺与舒芬太尼的镇痛效应为相加作用。
ObjectiveTo evaluate the analgesic interaction between butorphanol and sufentanil.MethodsNinety patients, aged 18-64 yr, with body mass index 〈30 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing elective laparoscopic gynecological surgery, were divided into 3 groups（n=30 each）using a random number table： butorphanol group（group B）, sufentanil group（group S）and butorphanol mixed with sufentanil group（group BS1）. The doses of butorphanol and sufentanil were determined by the modified Dixon′s up-and-down method.In B and S groups, the initial doses of butorphanol and sufentanil were 0.5 mg and 5 μg, respectively, with 0.1 mg and 1 μg increment/decrement, respectively.In group BS1, butorphanol combined with sufentanil at the ratio of 2∶1 based on the equivalent dose, and the initial dose was butorphanol 0.25 mg plus sufentanil 2.5 μg with 0.05 mg and 0.5 μg increment/decrement for butorphanol and sufentanil, respectively.Effective analgesia was defined as numeric rating scale pain score ≤ 3 or the extent of decrease in numeric rating scale scores 〉 50% within 15 min after administration.The median effective dose（ED50）and 95% confidence interval（CI）of butorphanol and sufentanil were calculated by probit analysis.Isobolographic analysis was used to analyze the analgesic interaction between butorphanol and sufentanil.When the equivalent dose of two drugs was very different from that selected in group BS1 on the basis of the actually calculated ED50 in B and S groups, the combination of butorphanol and sufentanil in group BS2（n=30）was set at the ratio of 1∶1 based on the actual equivalent dose： the initial dose was butorphanol 0.4 mg plus sufentanil 1.8 μg with 0.1 mg and 0.45 μg increment/decrement for butorphanol and sufentanil, respectively.ResultsThe ED50 of butorphanol was 0.80 mg（95% CI 0.74-0.87 mg）, and the ED50 of sufentanil was 3.68 μg（95% CI 3.07-4.41 μg）. The ED50 of butorphanol and sufentanil was 0.28 mg（95% CI 0.25-0.32 mg）and 2.82 μg（95% CI 2.52-3.16 μg）, respectively, in group BS1.The ED50 of butorphanol and sufentanil was 0.38 mg（95% CI 0.33-0.43 mg）and 1.7 μg（95% CI 1.5-1.9 μg）, respectively, in group BS2.The isobolographic analysis showed that the combination of butorphanol and sufentanil at 2∶1 or 1∶1 produced an additive analgesic effect.ConclusionThe analgesic effect of butorphanol and sufentanil is additive when combined at the ratio of 2∶1 or 1∶1 based on the equivalent dose.
出处
《中华麻醉学杂志》
CSCD
北大核心
2017年第8期975-978,共4页
Chinese Journal of Anesthesiology
