地佐辛预防瑞芬太尼复合七氟醚麻醉后诱发痛觉过敏的临床研究
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[摘要] 目的 评价地佐辛预防瑞芬太尼复合七氟醚麻醉诱发术后痛觉过敏的有效性和安全性。 方法 择期行上腹部手术患者120例，ASA分级Ⅰ或Ⅱ级，性别不限，年龄18～63岁，体重47～79 kg，采用随机数字表法，将其分为两组（n = 60）：芬太尼组（F组）、地佐辛组（D组）。手术结束前20 min时D组静脉注射地佐辛0.1 mg/kg，F组静脉注射芬太尼1 μg/kg。记录苏醒时间（睁眼时间）、拔除气管导管时间，记录苏醒后即刻（T0）、30 min（T1）、60 min（T2）时的视觉模拟评分（VAS）、布氏舒适评分（BCS）及镇静和躁动评分（SAS），记录拔管后呼吸抑制、恶心呕吐、瘙痒、尿潴留的发生情况。 结果 与F组比较，D组的苏醒时间和拔除气管导管的时间缩短（P ＜ 0.05），呼吸抑制、恶心呕吐、瘙痒的发生率降低（P ＜ 0.05）；T0时两组的VAS、BCS、SAS评分差异无统计学意义（P ＞ 0.05）；与T0时比较，T1、T2时F组的VAS、SAS评分升高，BCS评分降低（P ＜ 0.05）；D组不同时点VAS、BCS、SAS评分差异无统计学意义（P ＞ 0.05）；两组患者无一例发生尿潴留。 结论 手术结束前20 min静脉注射地佐辛0.1 mg/kg可有效减轻瑞芬太尼复合七氟醚麻醉患者的术后痛觉过敏，且不良反应少。
[关键词] 地佐辛；瑞芬太尼；七氟醚；痛觉过敏；镇痛
[中图分类号] R614.2 [文献标识码] A [文章编号] 1673-7210（2012）08（a）-0088-03
Clinical research of Dezocine in preventing postoperative hyperalgesia induced by Remifentanil-Sevoflurane anesthesia
JIN Hongxu WANG Zhongyi ZHANG Tongjun SUN Xuefei WANG Fuchao
Department of Anesthesiology, HARRISON International Peace Hospital Affiliated to Hebei Medical University, Hebei Province, Hengshui 053000, China
[Abstract] Objective To evaluate the effects of Dezocine on postoperative hyperalgesia induced by remifentanil-sevoflurane anesthesia in patients. Methods 120 cases of upper abdominal surgery, ASA Ⅰ or Ⅱ class, aged 18-63 years old, weighing 47-79 kg, were randomly divided into 2 groups (n = 60): Fentanyl group (group F), Dezocine group (group D). Group D received intravenous injection of Dezocine 0.1 mg/kg and group F received intravenous injection of Fentanyl 1 μg/kg at 20 min before the end of surgery. The emergence time (eyes opening time) and extubation time were recorded. Visual analog scale (VAS), bruggrmann comfort scale (BCS) and agitation scale (SAS) at immediately (T0), 30 min (T1), 60 min (T2) after emergence from anesthesia, and the incidence of respiratory depression, nausea and vomiting, pruritus and urinary retention after extubation were recorded. Results Compared with group F, the emergence time and extubation time were shortened (P ＜ 0.05), the incidence of side effects such as respiratory depression, nausea and vomiting and pruritus was decreased in group D (P ＜ 0.05). There were no significant differences of VAS, BCS and SAS scores at T0 between the two groups (P ＞ 0.05). Compared with T0, VAS and SAS scores were higher and BCS scores were lower at T1, T2 in group F (P ＜ 0.05), there were no significant differences of VAS, BCS and SAS scores at any time point in group D (P ＞ 0.05). No patients showed urinary retention in both groups. Conclusion Intravenous injection of Dezocine 0.1 mg/kg at 20 min before the end of surgery can reduce postoperative hyperalgesia with little side effects after Remifentanil-Sevoflurane anesthesia in patients.