诱导前给予地佐辛对口腔癌患者术后镇痛效果的影响  

Dezocine before induction enhances the postoperative analgesic effect in oral cancer patients

作　　者：赵保建[1] 董迎春[1] 王新河[1] 李珺[1] 张雪[1] 

机构地区：[1]南京大学医学院附属口腔医院南京市口腔医院麻醉科,210008

出　　处：《临床麻醉学杂志》2016年第11期1073-1075,共3页Journal of Clinical Anesthesiology

基　　金：国家自然科学基金(81100768)

摘　　要：目的探讨诱导前给予地佐辛对口腔癌根治术患者术后镇痛效果的影响。方法选择全麻下择期行口腔癌根治术患者60例,男36例,女24例,年龄35~65岁,ASAⅠ或Ⅱ级,随机分为两组,每组30例。于麻醉诱导前15min经静脉分别给予地佐辛0.15mg/kg（D组）或等量生理盐水5ml（C组）。术后均给予舒芬太尼静脉自控镇痛。检测注射地佐辛（或生理盐水）前（T_0）、术后2h（T_1）和12h（T_2）时血浆皮质醇（Cor）、促肾上腺皮质激素（ACT_H）和血清C反应蛋白（CRP）浓度。记录T_1、T_2和术后24h（T_3）时的VAS疼痛评分、BCS舒适度评级、Ramsay镇静评分。记录术后恶心、呕吐、低血压与皮肤瘙痒等不良反应情况。结果与T_0时比较,T_1、T_2时两组血浆Cor、ACT_H浓度及血清CRP浓度明显升高（P〈0.05）。T_1、T_2时D组血浆Cor、ACTH浓度及血清CRP浓度明显低于C组（P〈0.05）。T_1~T_3时D组VAS评分明显低于,Ramsay镇静评分明显高于C组,T_1、T_2时BCS舒适度评级明显高于C组（P〈0.05）。两组术后恶心、呕吐、低血压与皮肤瘙痒等不良反应发生率差异无统计学意义。结论诱导前给予地佐辛能有效减轻口腔癌根治术患者术后的应激反应,提高患者的舒适度,增强舒芬太尼术后镇痛的效果。Objective To explore the effect of dezocine before induction of general anesthesia on postoperative analgesia in patients,male 36 cases,female 24 cases,aged 35-65 years,ASA Ⅰ orⅡ,undergoing radical oral cancer resection.Methods Sixty patients undergoing oral cancer radical prostatectomy under general anesthesia were randomly divided into two groups with 30 in each group：groups C and D.Dezocine 0.15mg/kg was intravenously injected to the patients in group D 15 min before induction of general anesthesia.While the patients in group C received the same volume of saline solution at the same time.Patient controlled intravenous analgesia using sufentanil was used in all patients.Levels of blood cortisol（Cor）,adrenocorticotropic hormone（ACTH）and c-reactive protein（CRP）were analyzed at the time before injection with dezocine（or saline）（T_0）,2hafter surgery（T_1）and 12 h after surgery（T_3）.VAS pain score,BCS comfort scale,and Ramsay sedation scores of all patients were recorded at T_1,T_2 and the time of 24h（T_3）after surgery.Adverse reactions,including postoperative nausea,vomiting,low blood pressure and pruritus were recorded.Results Plasma Cor,ACTH concentration and serum CRP concentration of patients at T_1 and T_2 were increased significantly compared with T_0（P〈0.05）.Compared with those in group C,the concentrations of plasma Cor,ACTH and serum CRP in group D on T_1 and T_2 were significantly reduced（P〈0.05）.The VAS scores at T_1-T_3 in group D were lower than those of group C.While BCS comfort scale,Ramsay sedation score in group D were higher than those in group C（P〈0.05）.There was no significant difference in postoperative incidence of adverse reactions including postoperative nausea and vomiting,low blood pressure and pruritus between the two groups within 24 h.Conclusion Dezocine before induction of general anesthesia can effectively reduce the postoperative stress reaction of patients undergoing oral cancer radical operation,improve the patient＇s comfort

关 键 词：口腔癌 地佐辛 镇痛 应激 

分 类 号：R614[医药卫生—麻醉学] R739.8[医药卫生—外科学]