地佐辛超前镇痛在日间急诊开腹手术的应用  

Dezocine Preemptive Analgesia Application in Daytime Emergency Laparotomy

作　　者：李明[1] 和春燕[1] 李晓翠[1] 朱雁鸿[1] 

机构地区：[1]云南省玉溪市第一人民医院麻醉科,云南玉溪653100

出　　处：《医学综述》2015年第24期4572-4574,共3页Medical Recapitulate

摘　　要：目的探讨地佐辛用于日间急诊开腹手术超前镇痛的安全性和可行性。方法选取2013年7月至2014年6月在云南省玉溪市第一人民医院行日间急诊开腹手术患者135例,采用简单随机化方法将患者分为肌内注射组、静脉滴注组和对照组,各45例,手术结束前1 h分别给予肌内注射10 mg地佐辛、静脉滴注5 mg地佐辛和静脉滴注1 m L生理盐水。比较给药后三组急诊手术患者手术时间、苏醒时间、拔管时间,记录拔管时(T0)、拔管10 min(T1)、恢复室(T2)、术后6 h(T3)、术后12 h(T4)患者的Ramsay镇静评分以及T2、T3、T4时静息、运动视觉模拟评分(VAS)。结果三组急诊手术患者手术时间、手术失血量、术中输液量、拔管时间、恢复室停留时间比较差异均无统计学意义(P>0.05),苏醒时间和首次加镇痛药物时间比较差异有统计学意义(P<0.05)。肌内注射组与静脉滴注组的苏醒时间长于对照组[(6.9±1.6)min,(6.8±1.6)min比(6.0±1.5)min],差异有统计学意义(P<0.05)。肌内注射组首次加用镇痛药物时间肌内注射组长于静脉滴注组和对照组[(363.6±67.8)min比(234.6±62.8)min,(90.9±34.6)min],差异有统计学意义(P<0.05);三组患者Ramsay镇静评分在组间及组间·不同时点间交互作用比较,差异有统计学意义(P<0.05),但不同时点间比较差异无统计学意义(P>0.05),肌内注射组与静脉滴注组患者的Ramsay镇静评分比较稳定,而对照组波动稍大,呈升高的趋势,但12 h后三组患者的评分接近;静息VAS和运动VAS在组间、不同时点间及组间·不同时点间交互作用比较,差异均有统计学意义(P<0.05),肌内注射组患者的静息和运动VAS随时间的推移一直升高,而静脉滴注组和对照组是先升高后又降低,但12 h后三组患者的评分已接近。结论地佐辛用于日间急诊开腹手术超前镇痛是有效、可行的,以肌内注射为佳。Objective To investigate the safety and feasibility of dezocine for preemptive analgesia emergency laparotomy in daytime. Methods Total of 135 patients in Yuxi First People＇s Hospital from Jul.2013 to Jun. 2014 were sellected,then divided into intramscular injection group,intravenous drip group and control group by simple randomization method,1 h before the end of the surgery,the intramuscular injection group was given 10 mg dezocine by intramuscular injection,the intravenous drip group was given 5 mg dezocine by intravenous drip,and the control group was given 1 m L normal saline. The general conditions including operation time,recovery time,extubation time of the three groups were compared,the Ramsay sedation scores of the patients at extubation（ T0）,10 min after extubation（ T1）,recovery room（ T2）,6 h after operation（ T3）,12 h after operation（ T4） and resting and sport VAS at recovery room（ T2）,6 h after operation（ T3）,12 h after operation（ T4） were recorded. Results The operation time,blood loss,intraoperative fluid volume,extubation time,recovery room residence time of the three groups showed no significant difference（ P〈0. 05）,recovery time and the first time to add analgesics had statistically significant difference（ P〈0. 05）. The recovery time of the intramscular injection group and intravenous drip group were longer than the control group[（ 6. 9 ± 1. 6） min,（ 6. 8 ± 1. 6） min vs（ 6. 0 ± 1. 5） min],the difference had statistical significance（ P〈0. 05）. First time to add analgesics of the intramuscular injection group was later than the intravenous drip group and the control group [（ 363. 6 ± 67. 8） min vs（ 234. 6 ± 62. 8） min,（ 90. 9 ± 34. 6）min]（ P〈0. 05）. Ramsay sedation scores of the three groups between groups and groups · different time points had statistically significant difference（ P〈0. 05）,at difference time points had no statistically significant difference（ P〉0. 05）. The Ramsay sedation scores of

关 键 词：地佐辛 超前镇痛 急诊手术 

分 类 号：R971.2[医药卫生—药品]