地佐辛术前给药对腹腔镜结肠癌根治术患者苏醒期躁动和应激反应的影响  

The effects of preoperative injection with dezocine on stress response and agitation during extubation after laparoscopic colorectal surgery

作　　者：高燕凤[1] 袁伟[1] 霍雄伟[2] 陈亚丽[1] 丁晓英[3] 景桂霞[1] 吕毅[4] 

机构地区：[1]西安交通大学医学院第一附属医院麻醉科,710061 [2]西安交通大学医学院第一附属医院普通外科,710061 [3]西安交通大学医学院第二附属医院麻醉科 [4]西安交通大学医学院第一附属医院肝胆外科,710061

出　　处：《临床麻醉学杂志》2014年第9期863-866,共4页Journal of Clinical Anesthesiology

基　　金：陕西省科技攻关项目(2009K12-01)

摘　　要：目的观察地佐辛术前给药对全麻患者苏醒期躁动和应激反应的影响。方法择期行腹腔镜结肠癌根治术患者80例,男48例,女32例,采用随机数字表法分为四组,每组20例。A组:术前30min静注地佐辛10mg,术毕缝皮时给予生理盐水2ml;B组:术前30min给予生理盐水2ml,术毕缝皮时静注地佐辛10mg;C组:术前30min给予生理盐水2ml,术毕缝皮时静注芬太尼0.1mg;D组:术前30min、术毕缝皮时均予生理盐水2ml。记录患者在PACU的RSS躁动评分、拔管后即刻Ramsay镇静评分、苏醒时间、拔管时间及不良反应发生情况。检测记录用药前(T0)、手术结束时(T1)、拔管时(T2)的血浆皮质醇和血糖浓度。结果 T1、T2时,A、B、C组血浆皮质醇、血糖浓度明显低于D组,且A组明显低于B组和C组(P<0.05)。A、B、C组RSS躁动评分明显低于D组,且A组和B组明显低于C组(P<0.05)。拔管后即刻,A组和B组的Ramsay镇静评分明显高于C组和D组(P<0.05)。A、B、D组苏醒时间和拔除气管导管时间明显短于C组,C组有7例患者出现SpO2<90%(P<0.05)。结论与芬太尼比较,地佐辛降低全麻术后围拔管期躁动和应激反应的疗效更好,不良反应少,且术前应用较术后应用效果更佳,其机制可能与超前镇痛有关。Objective This study aimed to investigate the effects of preoperative injection with dezocine on stress response and agitation during extubation.Methods Eighty patients（ASA ⅠorⅡ）undergoing laparoscopic colorectal surgery with general anesthesia were randomly divided into four groups with 20 cases each.Group A received 10 mg dezocine intravenously 30 minutes before operation.Group B received 10 mg dezocine at the end of surgery.Group C received 0.1mg fentanyl at the end of surgery.And group D received 2ml saline 30 min before operation and at the end of operation.The RSS agitation score,Ramsay sedation score,VAS score,consciousness recovery time,extubation time and adverse events were recorded.Plasma cortisone and plasma glucose were assessed before injection（T0）,at the end of surgery（T1）and during extubation（T2）.Results Blood cortisone and glucose in group A,group B and group C were significantly lower than those in group D,while those in group A were significantly lower than those in group B and group C at T1 and T2（P〈0.05）.The scale and incidence of agitation in group A,group B and group C were significantly lower than those in group D,but those in group A and group B were significantly lower than those in group C（P〈0.05）.Ramsay scores in group A and group B were significantly higher than those in group C and group D at T2（P〈0.05）.The consciousness recovery time and extubation time in group C were longer than those in other groups（P〈0.05）.SpO2 was below 90% in seven patients of group C.Conclusion Preoperative injection of dezocine can reduce stress response and agitation effectively and safely during extubation.

关 键 词：地佐辛 术后躁动 应激反应 腹腔镜结肠癌手术 

分 类 号：R735.35[医药卫生—肿瘤]