地佐辛联合帕洛诺司琼对妇科手术病人罗哌卡因-芬太尼腰麻后皮肤瘙痒的影响  

EFFECT OF DEZOCINE COMBINED WITH PALONOSETRON ON PRURITUS AFTER ROPIVACAINE-FENTANYL SPINAL ANESTHESIA IN PATIENTS UNDERGOING GYNECOLOGICAL SURGERY

作　　者：侯倩 王焕亮 HOU Qian;WANG Huanliang(Department of Anesthesiology,Qilu Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院麻醉科,山东济南250012 [2]山东大学深圳研究院

出　　处：《青岛大学学报（医学版）》2021年第1期125-128,共4页Journal of Qingdao University(Medical Sciences)

基　　金：国家自然科学基金资助项目(81570044)。

摘　　要：目的评价地佐辛联合帕洛诺司琼静脉注射对妇科手术病人罗哌卡因-芬太尼腰麻后皮肤瘙痒的影响。方法收集择期行妇科手术病人140例,随机分为空白对照组(S组)、地佐辛组(D组)、帕洛诺司琼组(P组)和地佐辛+帕洛诺司琼组(DP组),每组35例。腰麻前10 min D组静脉注射地佐辛0.15 mg/kg,P组静脉注射帕洛诺司琼3μg/kg,DP组静脉注射地佐辛0.15 mg/kg和帕洛诺司琼3μg/kg混合液,S组静脉注射等体积生理盐水。右侧卧位于L3~4或L2~3间隙行腰麻穿刺,将罗哌卡因20 mg和芬太尼25μg混合液稀释至3 mL,取2.5 mL注入蛛网膜下隙,调整腰麻平面可满足手术要求后开始手术。给药后10~180 min记录生命体征、瘙痒评分、镇静评分及恶心呕吐评分。结果与S组比较,其余各组瘙痒评分明显降低(F=5.694、3.245,P<0.05),D组和DP组镇静评分明显升高(F=20.910,P<0.05),D组恶心呕吐评分明显升高(F=31.907,P<0.05);与D组比较,P组和DP组恶心呕吐评分明显降低(F=31.907,P<0.05)。结论地佐辛联合帕洛诺司琼静脉注射可有效抑制妇科手术病人罗哌卡因-芬太尼腰麻后皮肤瘙痒不良反应,具有满意的镇静效果,无明显恶心呕吐反应。Objective To investigate the effect of intravenously injected dezocine combined with palonosetron on pruritus after ropivacaine-fentanyl spinal anesthesia in patients undergoing gynecological surgery.Methods A total of 140 patients who underwent elective gynecological surgery were divided into blank control group(group S),dezocine group(group D),palonosetron group(group P),and dezocine+palonosetron group(group DP)using a random number table,with 35 patients in each group.Vital signs were monitored after they entered the operating room.At 10 min before spinal anesthesia,the patients in group D were given intravenously injected dezocine 0.15 mg/kg,those in group P were given intravenously injected palonosetron 3μg/kg,those in group DP were given intravenous injection of dezocine 0.15 mg/kg and palonosetron 3μg/kg,and those in group S were given intravenous injection of an equal volume of normal saline.Spinal anesthesia was performed in the L3-4 or L2-3 intervertebral space in the right lateral position.The mixture of ropivacaine 20 mg and fentanyl 25μg was diluted to 3 mL,and 2.5 mL of the mixture was injected into the subarachnoid space.The surgery started after the spinal level was adjusted to meet the surgical requirements.Vital signs,pruritus score,sedation score,and nausea/vomiting score were recorded at 10-180 min after administration.Results Compared with group S,the other groups had a significant reduction in pruritus score(F=5.694,3.245;P<0.05);group D and group DP had a significant increase in sedation score(F=20.910,P<0.05);group D had a significant increase in nausea/vomiting score(F=31.907,P<0.05).Compared with group D,group P and group DP had a significant reduction in nausea/vomiting score(F=31.907,P<0.05).Conclusion In patients undergoing gynecological surgery,intravenously injected dezocine combined with palonosetron can effectively inhibit the adverse reaction of pruritus after ropivacaine-fentanyl spinal anesthesia and has a satisfactory sedative effect,with little nausea/vomiting reaction.

关 键 词：瘙痒症 麻醉 脊椎 受体 阿片样 μ 血清素5-HT 3受体激动剂 妇科外科手术 

分 类 号：R614.41[医药卫生—麻醉学] R758.31[医药卫生—外科学]