鼻内镜手术后地佐辛的镇痛疗效和安全性观察

Clinical observation on analgesic effect and safety of dezocine after endoscopic nasal surgery

目的观察地佐辛在全麻下鼻内镜手术后两种不同给药方式的镇痛效果及其安全性。方法 96例择期行全麻下鼻内镜手术患者随机均分为A、B、C组,其中A组术后不使用镇痛药;B组术后静脉注射地佐辛10 mg;C组术后肌肉注射地佐辛10 mg。于手术结束后0.5、1、2、4、6 h分别进行视觉模拟评分(VAS),观察并记录不良反应。结果 B组和C组患者手术后0.5、1、2、4、6 h VAS评分明显低于A组患者(P<0.05);B组和C组患者在0.5、2、4 h VAS评分无明显差异(P>0.05);B组患者术后1、6 h VAS评分与C组患者比较差异具有统计学意义(P<0.05);不良反应比较,在恶心呕吐和呼吸抑制方面A组和C组无明显差异(P>0.05),A、C组与B组差异具有统计学意义(P<0.05);3组在头晕、嗜睡方面无显著差异(P>0.05).结论静脉注射和肌肉注射地佐辛均能在鼻内镜术后镇痛中产生良好的镇痛效果,静脉注射地佐辛的短期镇痛效果优于肌肉注射地佐辛;肌肉注射地佐辛可在较长时间内维持良好的镇痛效果,同时有较低的不良反应发生率,可以更加安全的运用于鼻内镜术后镇痛治疗。

Objective To observe the analgesic effect and safety of dezocine after endoscopic nasal surgery by two different methods of administration. Methods 96 patients received endoscopic nasal surgery were randomly divided into group A, B and C. After operation, the patients in group A, B and C were given no painkiller, intravenous injections of dezocine （ 10 mg ） and intramuscular injection of dezocine （ 10 mg） respectively. Visual analog scale （ VAS ） was used for rating the level of pain at time-points of 30 min, 1 , 2,4 and 6 h after the patients regained consciousness. Adverse effects in all patients were observed and recorded. Results The VAS scores of both group B and C at 0.5, 1 , 2,4 and 6 h were lower than those of group A （ all P 〈 0.05 ）. The differences of VAS scores between group B and C at 0.5,2 and 4 h were insignificant, while those at 1 and 6 h were significant. The incidence of postoperative nausea, vomiting and respiratory inhibition of group A and group C was lower than those of group B （ P 〈 0.05 ） , and the differences between group A and B, C and B were insignificant respectively. There were no significant differences in the incidence of somnolence and dizziness among the 3 groups. Conclusions Intravenous and intramuscular injections of dezoeine can provide good analgesic effect after endoscopic sinus surgery. The short-term effect provided by intravenous injection is superior to that by intramuscular injection, but intramuscular injection of dezocine could extend duration of good analgesic effect with lower incidence of adverse reactions. Therefore, dezoeine injected intramuscularly maybe a safe analgesic for postoperative analgesic therapy in endoscopic nasal surgery.