地佐辛用于老年髋部骨折手术椎管内麻醉前用药的临床研究  

Clinical Study of Dezocine as a Anesthetic Premedication for Hip Fracture Surgery Using Spinal Anesthesia in Elderly Patients

作　　者：何伟[1] 康定鑫[1] 朱纯纯[1] 李军[1] HE Wei;KANG Ding-xin;ZHU Chun-chun;LI Jun(Department of Anesthesiology,Perioperative Medicine,The Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第二医院麻醉科,浙江温州325000

出　　处：《海峡药学》2020年第10期82-85,共4页Strait Pharmaceutical Journal

基　　金：温州市科技局项目(编号:2017Y0596)

摘　　要：目的观察椎管内麻醉前不同剂量地佐辛用于老年髋部骨折患者的镇痛、镇静效果,评价地佐辛作为麻醉前用药的有效性和安全性。方法择期行髋部骨折内固定术的老年患者90例,随机分为3组,每组30例。入室后B、C组分别静注地佐辛3mg和5mg,A组静注等剂量生理盐水。观察各组患者入室时(T0)、给药后15min(T1)、麻醉体位摆放期(T2)的平均动脉压(MAP)、心率(HR)、呼吸(RR)、血氧饱和度(SpO2)、Ramsay镇静评分、疼痛评分(VAS),记录各组重度高血压(高血压三级)、低血压、呼吸抑制、恶心呕吐等不良情况。结果与A组比较,T1、T2时B、C组HR、MAP、RR、疼痛评分(VAS)明显降低,痛疼程度明显降低(P<0.05);Ramsay镇静评分较高,紧张情绪明显改善(P<0.05);且C组改变程度比B组更明显(P<0.05)。与A组比较,T2时B、C组重度高血压、心动过速发生率显著降低(P<0.05);但C组呼吸抑制、低血压以及恶心呕吐发生率显著高于B组(P<0.05)。结论老年髋部骨折患者椎管内麻醉前静注3mg地佐辛,能显著改善麻醉过程中的紧张情绪和疼痛程度,明显减少重度高血压发生率,血流动力学更理想,具有很好的临床参考意义。OBJECTIVE To observe the analgesic and sedative effect of different dose dezocine before spinal anesthesia for hip fracture surgery in elderly patie nts,and to evaluate the efficacy and safety of dezocine as a anesthetic premedication.METHODS 90 elderly patients undergoing elective hip fracture surgery were assigned randomly into three groups consisting of 30 patients each.3mg and 5mg dezocine were injected respectively to the patients in group B and group C by vein,the same dose saline was administered to the patients in group A.The heart rat(HR),the mean arterial blood pressure(MAP),the respiratory rate(RR),the blood oxygen saturation(SpO2),the pain score(VAS),the sedation score(Ramsay),severe hypertension(hypertension class Ⅲ),hypotension,respiratory depression,nausea and vomiting were recorded in three group when enter the opera tion room(T0),when 15min after the intravenous injection(T1)and when anesthesic operation(T2).RESULTS Compared with group A,the HR,MAP,RR,and pain score(VAS)of groups B and C were significantly reduced and the degree of pain was significantly relieved at T1 and T2(P<0.05).Ramsay has a high sedation score and a marked improvement in emotional stress(P<0.05);And the degree of change in group C was more significant than that in group B(P<0.05).Compared with group A,the incidence of severe hypertension and tachycardia in groups B and C was significantly decreased at T2(P<0.05).However,the incidence of respiratory depression,hypotension,and nausea and vomiting was significantly higher in group C than in group B(P<0.05).CONCLUSION 3mg dizocine administered before spinal anesthesia can significantly relieve pain and emotional stress for hip fracture surgery in elderly patients who have more stable hemodynamics,as a anesthetic premedication dezocine is efficacy and safety.

关 键 词：地佐辛 麻醉前用药 老年患者 髋部骨折 椎管内麻醉 

分 类 号：R969.4[医药卫生—药理学]