地佐辛在老年冠心病患者脊椎术后静脉镇痛中的应用

Application of dezocine in postoperative intravenous analgesia for spinal operation in elderly coronary heart disease patients

目的对冠心病患者中施行脊椎手术后比较地佐辛和芬太尼的静脉镇痛效果及对心血管不良事件发生的影响。方法高龄冠心病患者24例，随机分为地佐辛组和芬太尼组，每组12例。均为腰椎后路全椎板减压植骨融合内固定术。地佐辛组给予地佐辛，芬太尼组给予芬太尼，两组均加咪达唑仑，并以0．9％Nacl注射液稀释至100ml静脉镇痛。持续十二导联动态心电图监测，计算出患者24h心肌总缺血频度和缺血时间，以及心率变异性。并测定VAS评分及Ramsay镇静评分。结果两组心率变异性差异无统计学意义，地佐辛组的心肌缺血频度和缺血时间小于芬太尼组（P〈0．05）；2h时芬太尼组VAS评分略低于地佐辛组（P〈0．05），其余各时点VAS评分差异无统计学意义，各时点镇静评分差异无显著性。结论地佐辛具有良好的镇痛作用，且副作用轻微，是老年冠心病患者脊椎手术后静脉镇痛的一种理想选择。

Objective To compare the postoperative analgesic effect of dezocine with fentanyl, and investigate .the cardiovascular adverse events in coronary heart disease（CHD） patients undergoing lumbar decompression and fusion surgery. Methods Twenty four elderly patients with CHD were divided into two groups （n=12）： Dezocine group and Fentanyl group. In Dezocine group, dezocine and midazolam were solved into 100 ml normal saline, and fentanyl and midazolam in fentanyl group for postoperative analgesia. Total ischemia frequency, ischemia time and HRV were calculated by means of analysis of 24 hour dynamic electrocardiogram. The analgesia and sedation effects （VAS and Ramsay score） and side effect were observed. Results There was no statistical difference in HRV. The ischemia frequency and ischemia time in dezoeine group were lower than that in fentanyl group （P〈0.05）. VAS was no significantly statistical difference between the groups except for that of 2 h postoperatively. Conclusion Dezocine is a good choice for postoperative analgesia in elderly CHD patients after the spinal operation,with excellent analgesic effect and less side effects.