摘要
目的观察手术结束前给予地佐辛预防瑞芬太尼复合麻醉患者术后痛觉过敏的临床效果。方法选取择期全麻下行宫颈癌根治术患者72例,ASA分级Ⅰ或Ⅱ级,年龄30~65岁,体质量45~65 kg。采用随机数字表法分为3组(n=24):对照组(C组)、舒芬太尼组(S组)、地佐辛组(D组)。静脉注射咪达唑仑、舒芬太尼、丙泊酚和罗库溴铵行麻醉诱导,气管插管后行机械通气。术中以丙泊酚4~6 mg·kg^(-1)·h^(-1),瑞芬太尼0.3μg·kg^(-1)·min^(-1)维持麻醉深度,静脉间断注射顺式阿曲库铵0.04 mg/kg维持肌松。在手术结束前30 min,S组静脉注射舒芬太尼0.1μg/kg,D组静脉注射地佐辛0.2 mg/kg,C组给予等量生理盐水。入PACU后行PCIA镇痛方案:舒芬太尼用生理盐水稀释至100 ml,浓度1.5μg/ml,持续输注速率2 ml/h,PCIA剂量0.5 ml,锁定时间15 min。观察各组手术时间、瑞芬太尼输注时间和拔除气管导管时间。观察术后1 h、6 h舒芬太尼用量,并记录呼吸抑制、恶心、呕吐发生情况。结果3组手术时间、瑞芬太尼输注时间比较,差异均无统计学意义(P>0.05);与C组比较,S组拔除气管导管的时间明显延长(P<0.01),呼吸抑制、恶心及呕吐的发生率明显升高(P<0.01或P<0.05),C、D组拔除气管导管时间和术后不良反应发生率无明显差异(P>0.05);与C组比较,S组及D组术后1 h、6 h舒芬太尼用量明显减少(P<0.01)。与S组比较,D组术后不良反应发生率明显降低(P<0.01)。结论手术结束前30 min给予地佐辛可减轻瑞芬太尼复合麻醉诱导的术后痛觉过敏,且其不良反应较舒芬太尼少。
Objective To observe the clinical effect of dezocine in preventing postoperative hyperalgesia in patients undergoing remifentanil-based anesthesia. Methods 72 ASA Ⅰ or Ⅱ patients,aged 30 - 65,weighing 45 - 65 kg,undergoing radical resection of cervical cancer under general anesthesia,were randomly divided into 3 groups（ n = 24 each）,the control group（ group C）,sufentanil group（ group C） and dezocine group（ group D）. Aneshesia was induced with midazolam,sufentanil,propofol and rocuronium,and the patients were mechanically ventilated after tracheal intubation. During the operation,the depth of anesthesia was maintained with intravenous infusion of propofol 4 - 6 mg·kg-1·h-1,remifentanil 0. 3 μg·kg-1·min-1,and muscle relaxation was maintained with intermittent intravenous injection boluses of cisatracurium 0. 04 mg/kg. At 30 minutes before the end of surgery,S group was given intravenous sufentanil 0. 1 μg/kg,group D was intravenously administered with 0. 2 mg/kg of dizocine,and group C was given equal volume of normal saline. PCIA analgesia after admission to PACU： Sufentanil was diluted to 100 ml with saline,the concentration was 1. 5 μg/ml,the continuous infusion rate was 2 ml/h,the PCIA dose was 0. 5 ml,and the locking time was 15 min. The operation time,remifentanil infusion time,and tracheal extubation time were observed in each group. The amount of sufentanil was observed at 1 and 6 h after operation,and the occurrence of respiratory depression,nausea,and vomiting was recorded. Results There was no significant difference in the operation time and remifentanil infusion time between the three groups（ P〈0. 05）. Compared with group C,the time for removal of tracheal tube was significantly longer in group S（ P〈0. 01）,and the incidence of respiratory depression,nausea,and vomiting was significantly higher（ P〈0. 01 or P〈0. 05）. Compared with group C,the dose of sufentanil was significantly reduced at 1 and 6 h after operation in S group and D group（ P〈0. 01）. Co
作者
王兰兰
WANG Lan-lan(Fujian Cancer Hospital,Fuzhou,Fujian 350014,China)
出处
《临床合理用药杂志》
2018年第20期15-17,共3页
Chinese Journal of Clinical Rational Drug Use
关键词
镇痛药
阿片类
地佐辛
痛觉过敏
手术后并发症
Analgesics
Opioid
Dezocine
Hyperalgesia
Postoperative complications
