目的 探讨丁丙诺啡用于术后静脉自控镇痛（PCIA）对妇科患者术后恢复质量（QoR-15）及睡眠（PSQI）的影响。方法 选取2021年1月—2021年5月在天津市中心妇产科医院行择期妇科手术并选择使用术后镇痛泵100例患者，采用随机数字表法分为丁丙诺啡组和布托啡诺组，每组各50例。手术结束前15 min，丁丙诺啡组给盐酸丁丙诺啡注射液，3 μg/kg。布托啡诺组给予酒石酸布托啡诺注射液1 mg。手术结束后两组均予PCIA泵，丁丙诺啡组予15 μg/kg盐酸丁丙诺啡注射液配伍氟哌利多2 mg；布托啡诺组予120 μg/kg酒石酸布托啡诺注射液配伍氟哌利多2 mg。两组分别使用0.9%氯化钠稀释至100 mL，均采用同型号静脉自控镇痛泵，背景剂量2 mL/h，按压剂量0.5 mL，锁定时间15 min，术后48 h持续输注。采用QoR-15评分评估患者术后24、48 h恢复质量及PSQI评分评估患者术后1周睡眠质量、VAS评分评价患者的术后0～48 h疼痛情况，并统计患者恶心呕吐、呼吸抑制、便秘、头晕等不良反应的发生率。结果 两组患者术后48 h的QoR-15评分相较于术后24 h明显增高（P<0.05）；而术后24 h两组患者QoR-15评分无显著差异；术后48 h丁丙诺啡组QoR-15评分明显高于布托啡诺组（P<0.05）。术后1周，丁丙诺啡组PSQI评分显著低于布托啡诺组（P<0.05）。两组患者术后VAS评分均在0～4分，无中度及重度疼痛，且随着镇痛泵的持续使用，两组均在术后4 h（T₁）、12 h（T₂）、24 h（T₃）、48 h（T₄）的VAS评分低于术毕（T₀）（P<0.05）；而两组比较，术毕及术后4 h疼痛评分无显著差异；与布托啡诺组相比，丁丙诺啡组在T₂、T₃及T₄的VAS评分低于布托啡诺组（P<0.05）。两组患者PCIA按压次数比较差异无统计学意义。结论 丁丙诺啡可安全用于妇科全麻PCIA，且可以达到足够的镇痛效果及理想的恢复质量和睡眠质量，值得临床推广应用。

Objective To investigate the effect of buprenorphine on postoperative venous controlled analgesia (PCIA) in gynecological patients with postoperative quality of recovery (QOR-15) and sleep (PSQI). Methods A total of 100 patients who underwent elective gynecological surgery and used postoperative analgesia pump in Tianjin Central Hospital of Gynecology Obstetrics from January 2021to May 2021 were selected and divided into buprenorphine group and butorphanol group by random number table method, with 50 patients in each group. 15 Min before the end of operation, buprenorphine group was given Buprenorphine Hydrochloride Injection, 3 μg/kg. Butorphanol group was given Butorphanol Tartrate Injection 1 mg. After operation, both groups were given PCIA pump, buprenorphine group was given 15 μg/kg Buprenorphine Hydrochloride Injection combined with haloperidol 2 mg. Butorphanol group was given 120 μg/kg Butorphanol Tartrate Injection combined with 2 mg haloperidol. The two groups were diluted to 100 mL with 0.9% sodium chloride, respectively. The two groups were given the same type of intravenous self-controlled analgesia pump, with background dose of 2 mL/h and pressing dosage of 0.5 mL. The locking time was 15 min, and continuous infusion 48 h after surgery. Qor-15 score was used to evaluate the recovery quality of patients 24 h and 48 h after surgery, PSQI score was used to evaluate the sleep quality of patients 1 week after surgery, VAS score was used to evaluate the pain of patients 0 to 48 h after surgery, and the incidence of adverse reactions such as nausea and vomiting, respiratory depression, constipation and dizziness were analyzed. Results The QoR-15 score at 48 h after surgery was significantly higher in both groups than that at 24 h after surgery (P < 0.05). However, there was no significant difference in QoR-15 score between the two groups 24 h after surgery. Qor-15 score of buprenorphine group was significantly higher than that of butorphanol group at 48 h postoperatively (P < 0.05). One week after surgery, PSQI score in buprenorphine group was significantly lower than that in butolphanol group (P < 0.05). Postoperative VAS scores of both groups were 0-4, without moderate or severe pain, and VAS scores of both groups were lower than T₀ at T₂, T₃ and T₄ with continuous use of analgesic pump (P < 0.05). There was no significant difference in pain scores between the two groups after surgery and 4 h after surgery. Compared with butorphanol group, buprenorphine group had lower pain scores at T₁, T₂, T₃ and T₄ (P < 0.05). There was no significant difference in the number of PCIA compressions between the two groups. Conclusions Buprenorphine can be safely used in gynecological general anesthesia PCIA, and can achieve sufficient analgesic effect and ideal recovery quality and sleep quality, which is worthy of widespread clinical application.

R971

国家自然科学基金资助项目（81971879，81772043）；天津市自然科学基金资助项目（17JCYBJC24800）；天津市科技计划项目重点研发计划科技支撑重点项目（18YFZCSY00560）