目的 探討丁丙諾啡用于術(shù)后靜脈自控鎮(zhèn)痛（PCIA）對婦科患者術(shù)后恢復(fù)質(zhì)量（QoR-15）及睡眠（PSQI）的影響。方法 選取2021年1月—2021年5月在天津市中心婦產(chǎn)科醫(yī)院行擇期婦科手術(shù)并選擇使用術(shù)后鎮(zhèn)痛泵100例患者，采用隨機(jī)數(shù)字表法分為丁丙諾啡組和布托啡諾組，每組各50例。手術(shù)結(jié)束前15 min，丁丙諾啡組給鹽酸丁丙諾啡注射液，3 μg/kg。布托啡諾組給予酒石酸布托啡諾注射液1 mg。手術(shù)結(jié)束后兩組均予PCIA泵，丁丙諾啡組予15 μg/kg鹽酸丁丙諾啡注射液配伍氟哌利多2 mg；布托啡諾組予120 μg/kg酒石酸布托啡諾注射液配伍氟哌利多2 mg。兩組分別使用0.9%氯化鈉稀釋至100 mL，均采用同型號靜脈自控鎮(zhèn)痛泵，背景劑量2 mL/h，按壓劑量0.5 mL，鎖定時間15 min，術(shù)后48 h持續(xù)輸注。采用QoR-15評分評估患者術(shù)后24、48 h恢復(fù)質(zhì)量及PSQI評分評估患者術(shù)后1周睡眠質(zhì)量、VAS評分評價患者的術(shù)后0～48 h疼痛情況，并統(tǒng)計患者惡心嘔吐、呼吸抑制、便秘、頭暈等不良反應(yīng)的發(fā)生率。結(jié)果 兩組患者術(shù)后48 h的QoR-15評分相較于術(shù)后24 h明顯增高（P<0.05）；而術(shù)后24 h兩組患者QoR-15評分無顯著差異；術(shù)后48 h丁丙諾啡組QoR-15評分明顯高于布托啡諾組（P<0.05）。術(shù)后1周，丁丙諾啡組PSQI評分顯著低于布托啡諾組（P<0.05）。兩組患者術(shù)后VAS評分均在0～4分，無中度及重度疼痛，且隨著鎮(zhèn)痛泵的持續(xù)使用，兩組均在術(shù)后4 h（T₁）、12 h（T₂）、24 h（T₃）、48 h（T₄）的VAS評分低于術(shù)畢（T₀）（P<0.05）；而兩組比較，術(shù)畢及術(shù)后4 h疼痛評分無顯著差異；與布托啡諾組相比，丁丙諾啡組在T₂、T₃及T₄的VAS評分低于布托啡諾組（P<0.05）。兩組患者PCIA按壓次數(shù)比較差異無統(tǒng)計學(xué)意義。結(jié)論 丁丙諾啡可安全用于婦科全麻PCIA，且可以達(dá)到足夠的鎮(zhèn)痛效果及理想的恢復(fù)質(zhì)量和睡眠質(zhì)量，值得臨床推廣應(yīng)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

國家自然科學(xué)基金資助項目（81971879，81772043）；天津市自然科學(xué)基金資助項目（17JCYBJC24800）；天津市科技計劃項目重點(diǎn)研發(fā)計劃科技支撐重點(diǎn)項目（18YFZCSY00560）