地佐辛预防瑞芬太尼复合麻醉患者术后痛觉过敏的效果  

Preventive effects of dezocine on postoperative hyperalgesia in patients after remifentanil-based anesthesia

作　　者：骆宏[1] 杨恒[1] 胡友洋[1] 张地宝[1] 

机构地区：[1]合肥市第一人民医院麻醉科,230061

出　　处：《中华麻醉学杂志》2011年第10期1213-1216,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价地佐辛预防瑞芬太尼复合麻醉患者术后痛觉过敏的效果。方法择期行腹腔镜胆囊切除术患者100例，年龄20～64岁，体重45～65kg，ASA分级Ⅰ或Ⅱ级，采用随机数学表法，将其随机分为4组（n=25）：芬太尼组（F组）、低剂量地佐辛组（D，组）、中剂量地佐辛组（D2组）和高剂量地佐辛组（D，组）。静脉注射咪达唑仑、异丙酚、瑞芬太尼和顺阿曲库铵麻醉诱导，气管内插管后机械通气。麻醉维持：靶控输注瑞芬太尼，效应室靶浓度4μg/L，静脉输注异丙酚4—6mg·kg-1·h-1，间断静脉注射顺阿曲库铵0．03mg／kg。手术结束前30min时D1组、D2组和D3组分别肌肉注射地佐辛0．1、0．2、0．3mg／kg，F组手术结束前15min静脉注射芬太尼1μg/kg。记录苏醒时间、拔除气管导管时间，记录苏醒后即刻、1h、2h（T0～T2）时视觉模拟评分（VAS）、布氏舒适评分（BCS）和镇静和躁动评分（SAS），记录拔除气管导管后呼吸抑制、恶心呕吐及尿潴留的发生情况。结果与F组比较，D1组、D2组和D3组苏醒时间和拔除气管导管时间缩短，呼吸抑制和恶心呕吐发生率降低；D。组各时点VAS评分升高，BCS评分降低，D：组和D]组R时VAS评分升高，T1,2时VAS评分降低，T0-2时SAS评分降低（P〈0．05）；与D2组比较，D1组T0-2时SAS评分降低，呼吸抑制发生率升高（P〈0．05）；4组无一例患者发生尿潴留。结论手术结束前30min肌肉注射地佐辛0．2mg／kg可减轻瑞芬太尼复合麻醉患者麻醉恢复期痛觉过敏，且副作用小。Objective To evaluate the preventive effects of dezocine on postoperative hyperalgesia in patients after remifentanil-based anesthesia. Methods One hundred ASAⅠor Ⅱpatients, aged 20-64, weighing 45-65 kg, undergoing laparoscopic cholecysteetomy, were randomly divided into 4 groups （ n = 25 each） ： fentanyl group （ group F）, low-dose dezoeine group （ group D1 ）, medium-dose dezocine group （ group D2 ） and higb-dose dezocine group （group D3 ）. Anesthesia was induced with midazolam, propofol, remifentanil and cisatracurium. The patients were mechanically ventilated after tracheal intubation. Anesthesia was maintained with target-controlled infusion of remifentanil （target effect-site concentration 4 9g/L ）, intravenous infusion of propofol 4-6 mg·kg-1·h-1 and intermittent intravenous injection of cisatracurium 0.03 mg/kg. Groups D1 , D2 and D3 received intramuscular injection of dezocine 0.1,0.2,0.3 mg/kg at 30 min before the end of surgery respectively and group F received intravenous injection of fentanyl 1 μg/kg at 15 min before the end of surgery. The emergence time and extubation time were recorded. Visual analog scale（VAS）, Bruggrmann comfort scale（BCS） and sedation and agitation scale （SAS） at immediately, 1 h,2 h after emergence from anesthesia （T0.1,2 ）, and the incidence of respiratory depression, nausea and vomiting and urinary retention after extubation were recorded. Results Compared with group F, the emergence time and extubation time were shortened, the incidence of respiratory depression and nausea and vomiting was decreased in groups Dl , D2 and D3 , VAS score was increased and BCS score was decreased at T0-2 in group D1 , VAS score at T0 was increased,while VAS score at T1-2 and SAS score at T0-2 was decreased in groups D2 and D3 （ P 〈 0.05） . Compared with group D2, SAS score was decreased at T0-2 , while the incidence of respiratory depression was increased in group D3 （ P 〈 0.05 ） . No patient showed urinary retention in the four group

关 键 词：哌啶类 痛觉过敏 麻醉 全身 手术后并发症 地佐辛 

分 类 号：R614[医药卫生—麻醉学]