术中应用地佐辛对丙泊酚复合瑞芬太尼麻醉恢复的影响

Effect of dezocine with remifentanil-propofol on analgesia recovery

目的探讨术毕应用不同浓度地佐辛对丙泊酚复合瑞芬太尼麻醉恢复的影响。方法80例美国麻醉师协会分级Ⅰ或Ⅱ级的择期腹腔镜胆囊切除术患者，完全随机分为4组，均采用全凭静脉麻醉加气管插管，术中靶控输注瑞芬太尼及丙泊酚，间断给予维库溴铵维持麻醉。关腹前15min分别静脉注射地佐辛0．05mg／kg（A组，n=20）、0．1mg／kg（B组，n=20）、0．15mg／kg（C组，n=20），对照组（n=20）不给予地佐辛。评定患者拔管后疼痛和镇静程度，记录患者呼吸恢复、意识恢复和拔管时间以及拔管后麻醉恢复室内患者芬太尼处理例数和用量及其恶心呕吐及烦躁等不良反应。结果C组的视觉模拟评分（VAS）明显低于A、B组及对照组[（1．4±0．7）比（2．4±0．9），（2．1±0．8），（5．1±1．3），P〈0．05]；C组Ramsay评分明显高于A、B组及对照组[（2．2±0．7）比（1．8±0．6），（1．7±0．6），（1．5±0．6），P〈0．01]。C组的呼吸恢复、意识恢复和拔管时间明显延长于A、B和对照组[（15．7±2．5）min比（9．6±1．4）min，（10．7±1．8）min，（9．2±1．5）min；（18．1±0．7）min比（12．4±2．0）min，（13．1±1．8）min，（13．9±3．1）min；（21．4±2．3）min比（15．0±1．8）min，（15．6±1．6）min，（14．8±1．8）min，各项参数P〈0．01]。结论在腹腔镜胆囊切除术手术结束前15min应用0．05mg／kg或0．1mg／kg地佐辛可减轻瑞芬太尼停药后的疼痛反应，但不明显延长苏醒和拔管时间。

Objective To observe the effect of dezocine on the recovery of analgesia with remifentanilpropofol. Methods Eighty patients with American Society of Anesthesiologists Ⅰ or Ⅱ undergoing elective laparoscopic cholecystectomy under general anesthesia were randomly divided into four groups with intravenous anesthesia plus intubation, intraoperative remifentanil and propofol target-controlled infusion plus intermittent veeuronium to maintain anesthesia： 0.05 mg/kg （ group A, n = 20 ） ,0.1 mg/kg （ group B, n = 20 ）, 0.15 mg/kg （ group C, n = 20 ） of dezoeine were given before 15 rain before the end of surgery. Control group was not given any agents （n = 20 ）. Analgesia was evaluated by Visual analogue scale （VAS）and sedation by Ramsay scoring during recovery from anesthesia. The recovery time of respiration, extubation, consciousness, frequencies of additional narcotic analgesic administration were recorded. Results The VAS score of group C was less than that of group A, B and control group [ （ 1.4 ±0.7 ） vs （ 2.4 ± 0.9 ）, （ 2.1 ± 0.8 ）, （ 5.1 ± 1.3 ）, P 〈 0.05 ]. The Ramsay score of group C was greater than that of groupA,Bandcontrolgroup[（2.2±0.7） vs （1.8±0.6）,（1.7±0.6）,（1.5±0.6）,P〈0.01]. The recovery time of respiration, extubation and consciousness were longer than that of group A, B and control group [（15.7±2.5）min vs （9.6 ±1.4）min,（10.7 ±1.8）min,（9.2±1.5）min;（18.1 ±0.7）min vs （12.4± 2.0）min,（13.1±1.8）min,（13.9±3.1）min;（21.4±2.3）minvs （15.0±1.8）min,（15.6±1.6）min,（14.8± 1.8 ） min, P 〈 0.01 ]. Conclusion The administration of dezocine 0.05 or 0.1 mg/kg at 15 min before the end of surgery may be an optimal strategy for attenuating the early pain after stoping infusion of remifentanil without significantly delaying the recovery from propofo-remifentanil anesthesia and extubation time.