地佐辛超前镇痛的临床应用

The clinical application of the preemptive analgesia with dezocine

目的:观察地佐辛麻醉前肌内注射超前镇痛对术后镇痛效果的影响及不良反应发生率,为该药的临床应用提供理论依据。方法:采用随机双盲法将患者分为3组,每组20例。组1:手术后行PCEA;组2:在硬膜外麻醉前肌内注射地佐辛5mg,术后行PCEA;组3:手术结束肌内注射地佐辛5 mg同时行PCEA。药物均采用0.000 5%芬太尼+0.2%罗哌卡因。采用视觉模拟评分法(VAS)记录平静及活动时VAS评分,记录平静及活动时PCA按压次数(Demand)与实进次数(Delivery)比值,即D/D比值,据此推算平静及活动时额外芬太尼用量。结果:VAS评分组1明显高于组2、组3(P<0.01),组2与组3比较无显著性意义(P>0.05);额外辅助芬太尼用量组1最多(P<0.01),组2最少,组2与组3相比有显著性差异(P<0.05)。D/D比值在0～2范围内的病例数组2最多,组1最少(P<0.01),组2与组3相比有显著性差异(P<0.05)。结论:术前预用地佐辛能显著降低患者对疼痛的敏感性,增强术后芬太尼镇痛效果,具有一定的超前镇痛效果。

OBJECTIVE To observe the influence on the effect of postoprative analgesia by preemptive analgesia with dezo cine through intramuscular injection and the incidence of adverse reactions. METHODS A randomized double-blind clinical tri al was conducted, the patients were divided into three groups and each group had 20 patients. Group 1 ： having PCEA after theoperations. Group 2： giving intramuscular injection of 5 mg dezocine before the epidural anesthesia, then having PCEA after the operations. Group 3： after the operations, giving intramuscular injection of 5 mg dezocine and PCEA at the same time. Drugs of PCEA included 0. 000 5% fentanyl and 0. 2% ropivacaine. The pain was assessed by visual analogue scale （VAS）. Recorded the scores whenever the patients were still or moving. Capcul.ated the additional dose of fentanyl by the ratio ot the num ber of pressing the PCA （Demand） and the real delivery number （Delivery）, abbreviated as D/D. RESULTS There was no sig nificant difference of the general characters among the patients in the three groups （P〉0.05）. VAS score of group 1 was sig nificantly higher than that of group2 （P〈0. 01 ）, and there was no significant difference between group 2 and group 3 （P〉0. 05）. Group 1 had the most additional dose of fentanyl and group 2 had the least. There was significant difference between group 2 and group 3（P〈0. 05）. CONCLUSION Using dezocine before operations can significantly reduce the sensitivity of pain and enhance the effect of fentanyl after operations. Dezocine has the effect of preemptive analgesia .