地佐辛与曲马多术后早期镇痛效果的比较  

Dezocine versus tramadol for early postoperative analgesia after laparoscopic cholecystectomy

作　　者：曾兆东[1] 程明华[1] 林树勇[1] 庄少惠[1] 

机构地区：[1]汕头大学医学院第一附属医院麻醉科,515041

出　　处：《中国医药》2011年第6期698-699,共2页China Medicine

摘　　要：目的比较地佐辛与曲马多单次静脉给药用于腹腔镜胆囊切除术后患者患者早期镇痛的效果及不良反应。方法选择择期行腹腔镜胆囊切除术患者40例，美国麻醉师协会Ⅰ～Ⅱ级，年龄18—65岁，完全随机分为地佐辛组和曲马多组，各20例，均采用气管插管全身静脉麻醉。术中靶控输注异丙酚、瑞芬太尼，间断给予顺式阿曲库铵维持麻醉。地佐辛组关腹前30min分别静脉注射地佐辛0．1mg／kg、曲马多组给予曲马多2mg／kg。记录2组术前（T0）、给药时（T1）、拔管时（T2）、拔管后5min（T3）、拔管后10min（T4）、拔管后30min（T5）、拔管后1h（T6）患者的HR、SBP、DBP和动脉血氧分压（SpO2），并观测苏醒时间、拔管时间以及L、T4、L、T6的视觉模拟评分（vAs），观察拔管后患者的不良反应情况。用警觉／镇静评分评估患者全麻后意识恢复程度。结果地佐辛组T2、T3时间点心率分别为（105±11）、（96±10）次／min，明显低于曲马多组[分别为（93±6）、（87±6）次／min，P〈0．05]，SpO2在T2、T3、T。时间点差异无统计学意义，T4时间点地佐辛组VAS评分明显高于曲马多组[（2．06±0．85）分比（2．69±0．93）分，P〈0．05]。曲马多组呼吸抑制1例，恶心呕吐3例，躁动2例；地佐辛组呼吸抑制1例，躁动1例，头晕1例。2组不良反应发生情况差异无统计学意义。结论地佐辛在拔管早期对抑制拔管反应的作用和镇痛比曲马多好，不良反应较少。Objective To study the effect of dezocine versus tramadol for postoperative analgesia and side effects after laparoscopic choleeystectomy. Methods Forty patients with postoperative analgesia, American Society of Anesthesiologists Ⅰ- Ⅱ class, were randomly divided into two groups. Target eontrolled infusion of propofol and remifentanly was used to both groups. Both groups were given intermittent eisatracurium. The single intravenous injections of dezocine （0.1 mg/kg）and tramdol（ 2 mg/kg）were given before 30 rain of operation closure. The analgesic efficacy and side effects was assessed by verbal and visual scales at regular intervals after administration. Hemodynamic parameters and SpO2 were recorded, before operation, after administration, extubation time, 5, 10, 30, 60 min after extubation. The visual analogue scale（VAS） pain score and OAA/S score of 5, 10, 30, 60 min after extubation were conducted. Adverse reactions with nausea and vomiting and dysthesia after extubation were obtained. Results There was statistical significance of hemodynamic parameters of extubation （P 〈 0.05 ）. Tramadol group （ Group T） has the highest incidence of nausea and vomiting. Dezocine group（Group D）has the highest VAS score after recovery （P 〈 0.05 ）. There were no significant changes in respiratory parameters. Conclusion A single 0.1 mg intravenous injection of dezocine is safe and effective for postoperative pain after laparoscopic cholecystectomy.

关 键 词：地佐辛 镇痛 曲马多 

分 类 号：R971.2[医药卫生—药品]