不同剂量地佐辛用于腹部大手术后自控静脉镇痛的临床观察  

Effect of the patient-controlled intravenous analgesia with different doses of dezocine in patients undergoing major abdominal surgery

作　　者：张玉龙[1] 夏闵涛[1] 王义琛[1] 浦江[1] 

机构地区：[1]苏州大学附属常州肿瘤医院麻醉科,213001

出　　处：《国际麻醉学与复苏杂志》2014年第2期131-133,157,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨不同剂量的地佐辛用于腹部大手术后患者自控静脉镇痛（patient-controlledintravenousanalgesia，PCIA）的临床疗效和最适有效剂量。方法将拟行腹部大手术美国麻醉医师协会（ASA）分级I或Ⅱ级的患者60例按照随机数字表分为A、B、C3组，每组20例。术毕前20min患者均静脉注射地佐辛0．12mr／ks负荷量，术后均行PCIA，镇痛液中地佐辛含量分别为0．012mg·kg-1·h-1（A组）、0．014mg·kg-1·h-1（B组）、0．016mg·kg-1·h-1（C组）。观察术后6、12、24、48h疼痛视觉模拟评分（visualanaloguescores，VAS）、Ramsay评分、镇痛药液消耗量、总按压次数和有效按压次数，并记录术后恶心呕吐、头晕、呼吸抑制等副作用。结果术后6、12、24、48hVAS评分，C组[（1．8±1．1）、（1．5±0．8）、（1．3±0．9）、（1．1±0．9）]明显低于A组[（3．0±1．1）、（2．4±0．9）、（2．0±0．7）、（1．8±0．8）]与B组[（2．8±1．0）、（2．3±0．6）、（1．8±0．8）、（1．7±0．7）]（P〈0．05）。术后6、12hRamsay评分，C组[（2．2±0．6）、（2．3±0．6）]显著高于A组[（1．7±0．7）、（1．8±0．6）]和B组[（1．8±0．6）、（1．9±0．6）]（P〈0．05）。术后48h内A、B组的患者自控镇痛（patientcontrolledanalgesia，PCA）总按压次数、有效按压次数及镇痛药液消耗量明显高于C组（氏0．05），C组镇痛总体满意度优于A、B组（P〈0．05）。3组副作用发生率比较差异无统计学意义。结论地佐辛0．016mg·kg-1·h-1用于腹部手术后PCIA效果较好，不增加副作用发生率。Objective To investigate the analgesic effect of different doses of dezocine on a patient-controlled intravenous analgesia（PCIA） for pain control after major abdominal surgery. Methods Sixty patients （ASA I or H ） undergoing major abdominal surgery were randomly divided into three groups of A, B, and C （n=20）. Patients received a dezocine loading dose of 0.12 mg/kg at 20 min before the end of surgery. The background infusion of dezocine is 0.012, 0.014 mg·kg-1·h-1 and 0.016 mg·kg-1·h-1 in group A, B, and C, respectively. Visual analogue scores （VAS）, Ramsay score, the analgesic consumption, the total number of patient controlled analgesia （PCA）, the effective number of PCA, and the side effects （nausea, vomiting, dizziness and respiratory depression） were recorded at 6, 12, 24, 48 h postoperatively. Results At 6, 12, 24, 48 h postoperatively, the VAS scores in group C [（1.8±1.1）, （1.5±0.8）, （1.3±0.9）, （1.1±0.9）] were significantly lower than those of group A[（3.0±1.1）, （2.4±0.9）, （2.0±0.7）, （ 1.8±0.8 ） ] and B [ （2.8± 1.0）, （2.3±0.6）, （ 1.8 ±0.8）, （ 1.7±0.7 ） ] （P〈O.05）. Meanwhile, the Ramsay scores were higher in group C[（2.2±0.6）, （2.3±0.6） ] than those in group A [（1.7±0.7）, （1.8±0.6）] and B[（1.8±0.6）, （1.9±0.6）]（P〈0.05） at 6 h and 12 h after surpery. The scores of satisfaction of postoperative analgesia, analgesic consumption, the total and effective number of PCA were also lower in group C than the other groups （P〈0.05）. Moreover, there is no statistical difference on the incidence of adverse effects among the three groups. Conclusions Patient-controlled intravenous analgesia with 0.016 mg·kg-1·h-1 dezocine shows the best analgesic effect, and the similar incidence of side effects.

关 键 词：地佐辛 术后自控静脉镇痛 腹部手术 

分 类 号：R614[医药卫生—麻醉学]