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目的:研究不同时间点静脉注射布托啡诺对胸腔镜肺叶切除术肺癌患者应激反应、停药苏醒时间、苏醒期躁动、术后疼痛的影响。方法:选取山西医科大学第二医院2019年9月至2020年5月择期行胸腔镜肺叶切除术的肺癌患者90例，按随机数字表法分为三组，每组30例。A组（超前镇痛组）在麻醉诱导前15 min注射布托啡诺20 μg／kg，B组在术毕前30 min注射布托啡诺20 μg／kg，C组（空白对照组）在相应时刻给予相同体积的0.9% NaCl注射液。观察三组患者不同时刻的血糖、皮质醇、心率、平均动脉压（MAP）及缝皮停药苏醒时间、苏醒期的躁动评分和躁动发生率、术后疼痛视觉模拟评分（VAS）。结果:A组缝皮结束即刻以及术后6 h的血糖[（5.25±0.32）、（5.17±0.58）mmol／L]、皮质醇[（253.63±48.29）、（222.17±35.73）ng／ml]均低于B组[（5.85±0.53）、（5.52±0.48）mmol／L，（302.83±48.63）、（274.87±47.93）ng／ml]和C组[（6.07±0.70）、（5.68±0.52）mmol／L，（319.97±32.05）、（295.57±46.83）ng／ml]（均n P0.05）。A组插管时MAP和心率较诱导前高（均n P0.05）；B组和C组插管时、单肺通气后30 min、拔管时的心率及MAP与诱导前相比均升高（均n P<0.05）。B组的停药苏醒时间[（16.53±3.64）min]长于A组[（13.83±3.24）min]、C组[（12.47±3.35）min]（均n P0.05）。A组苏醒期躁动评分和躁动发生率[（3.20±0.41）分，0（0／30）]均低于B组[（3.73±0.74）分，7%（2／30）]、C组[（4.00±0.79）分，10%（3／30）]（均n P<0.05）。A组术后3 h和12 h的疼痛VAS[（3.10±0.61）分、（3.27±0.52）分]均低于相同时刻B组[（3.53±0.86）分、（3.70±0.53）分]和C组[（4.00±0.83）分、（4.10±0.71）分]（均n P0.05）。n 结论:对接受胸腔镜手术的肺癌患者而言，布托啡诺超前镇痛不仅能够减少应激反应，增加术中血流动力学的稳定性，而且还能在不延长停药苏醒时间的情况下，有效降低患者术后疼痛及躁动的发生概率。“,”Objective:To study the effect of intravenous injection with butorphanol at different time points on stress response, recovery time after drug withdrawal, emergence agitation and postoperative pain in lung cancer patients undergoing thoracoscopic lobectomy.Methods:A total of 90 lung cancer patients who underwent elective thoracoscopic lobectomy from September 2019 to May 2020 in the Second Hospital of Shanxi Medical University were selected and randomly divided into three groups according to random number table, 30 cases in each group. Group A was set as a preemptive analgesia group, and 20 μg/kg butorphanol was injected intravenously at 15 min before anesthesia induction; group B was injected with 20 μg/kg butorphanol at 30 min before the end of operation; and the blank control group (group C) was given with the same volume of 0.9% NaCl injection at the same time points. The following data including blood glucose, cortisol, heart rate and mean arterial pressure (MAP), recovery time after skin suture and drug withdrawal, emergence agitation score and incidence rate of restlessness, postoperative pain visual analogue scale (VAS) were observed.Results:The level of blood glucose [(5.25±0.32), (5.17±0.58) mmol/L] and cortisol [(253.63±48.29), (222.17±35.73) ng/ml] in group A were lower than those in group B [(5.85±0.53), (5.52±0.48) mmol/L; (302.83±48.63), (274.87±47.93) ng/ml] and group C [(6.07±0.70), (5.68±0.52) mmol/L; (319.97±32.05), (295.57±46.83) ng/ml] immediately after skin suture and 6 h after the operation (alln P 0.05). The levels of MAP and heart rate in group A at intubation were higher than those before anesthesia induction (all n P 0.05). In group B and group C, heart rate and MAP at intubation, 30 min after one-lung ventilation and extubation were higher than those before anesthesia induction (all n P < 0.05). Among them, the recovery time after drug withdrawal in group B [(16.53±3.64) min] was longer than that in group A [(13.83±3.24) min] and group C [(12.47±3.35) min] (all n P 0.05). In addition, in terms of emergence agitation score and agitation incidence, group A [(3.20±0.41) scores, 0 (0/30)] was lower than group B [(3.73±0.74) scores, 7% (2/30)] and group C [(4.00±0.79) scores, 10% (3/30)] (all n P < 0.05). The pain VAS in group A [(3.10±0.61) scores, (3.27±0.52) scores] at 3 h and 12 h after operation were lower than those in group B [(3.53±0.86) scores, (3.70±0.53) scores] and group C [(4.00±0.83) scores, (4.10±0.71) scores] at the same time points (all n P 0.05).n Conclusions:For lung cancer patients who underwent thoracoscopic lobectomy, preemptive analgesia with butorphanol not only can reduce the stress response and increase the stability of hemodynamics, but also can effectively reduce the incidence of postoperative pain and restlessness without prolonging the recovery time after stopping drug.