目的 探讨盐酸丁丙诺啡注射液复合氟哌利多注射液用于胸科术后静脉自控镇痛(PCIA)。方法 选取2022年5月-2023年2月在邯郸市中心医院择期全麻下行胸腔镜下肺叶切除术的100例患者,所有患者按照计算机随机数字表法分为丁丙诺啡组和舒芬太尼组,每组各50例。手术结束前30 min,丁丙诺啡组给予盐酸丁丙诺啡注射液3 μg/kg,舒芬太尼组给予枸橼酸舒芬太尼注射液15 μg。术后两组患者均采用PCIA,丁丙诺啡组:盐酸丁丙诺啡注射液15 μg/kg+氟哌利多注射液2 mg+0.9%氯化钠稀释至150 mL;舒芬太尼组:枸橼酸舒芬太尼注射液2.5 μg/kg+氟哌利多注射液2 mg+0.9%氯化钠稀释至150 mL。比较术毕(T0)、术后2 h(T1)、4 h(T2)、6 h(T3)、12 h(T4)、24 h(T5)、48 h(T6)静息和咳嗽时的VAS评分。记录拔出气管导管时两组血流动力学波动情况。比较术后24、48 h的QoR-15评分、曲马多镇痛补救量、PCIA泵按压次数、不良反应发生情况。结果 两组术后静息和咳嗽时2 h(T1)、4 h(T2)、6 h(T3)、12 h(T4)、24 h(T5)、48 h(T6)的VAS评分均低于术毕(T0)(P<0.05)。患者拔出气管导管时丁丙诺啡组患者的血流动力学波动小于舒芬太尼组(P<0.05)。丁丙诺啡组恶心呕吐、呼吸抑制发生例数少于舒芬太尼组(P<0.05)。结论 盐酸丁丙诺啡注射液合氟哌利多注射液在胸科围术期能减轻苏醒拔管时机体的应激反应,呼吸抑制、恶心呕吐发生率低,用于术后镇痛可达到良好的镇痛效果和理想的恢复质量。

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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