地佐辛联合地塞米松超前镇痛的应用

The Application of Dezocine and Dexamethasone in Preemptive Analgesia

目的:观察静脉注射地佐辛联合地塞米松用于腹腔镜胆囊切除术超前镇痛的效果。方法:选择ASAⅠ～Ⅱ级择期腹腔镜胆囊切除术患者90例,随机分为三组,每组30例,Ⅰ组术前静脉注射地佐辛0.1mg/kg+地塞米松10mg,Ⅱ组术前静脉注射注射地佐辛0.1mg/kg,Ⅲ组为对照组,未应用药物。观察患者术后2h(T1)、6h(T2)、12h(T3)、24h(T4)、48h(T5)的VAS、BCS评分、Ramsay镇静评分、镇痛药、止吐药追加情况及不良反应。结果:术后各个时间点,Ⅰ组的VAS低于Ⅱ组和Ⅲ组,BCS评分都高于Ⅱ组和Ⅲ组(P<0.05);Ⅱ组术后6h的VAS评分低于其他各个时点(P<0.05);三组间Ramsay评分比较差异无统计学意义(P>0.05)。Ⅲ组恶心、呕吐及咽喉不适发生率高于Ⅰ组和Ⅱ组(P<0.05);Ⅱ组和Ⅲ组追加镇痛药的次数高于Ⅰ组(P<0.05)。结论:地佐辛联合地塞米松超前镇痛在腹腔镜胆囊切除术中具有协同作用,能延长术后镇痛时间,减少镇痛药的使用,副作用少。

Objective：To observe the preemptive analgesic effect of intravenous dezocine in combination with dexamethasone in laparoscopic cholecystectomy（LC）. Methods： In this study, 90 patients graded as ASA Ⅰ～Ⅱ who were undergoing elective laparoscopic cholecystectomy were selected. They were randomly divided into three groups with 30 patients in each group. Group Ⅰ： dezocine 0.1 （mg·kg） and dexamethasone 10 mg intravenous injection was given preoperatively. Group Ⅱ： dezocine 0.1 mg kg intravenous injection was given preoperatively. Group Ⅲ was control group. VAS and BCS score, Ramsay composure score, the superaddition and adverse effect of analgesics and antanacathartic were assessed in each individual group. Results： VAS score of Group Ⅰ was lower than that of Group Ⅱ and Ⅲ, and the BCS score of Group Ⅰ was higher than that of Group Ⅱ and Ⅲ（P0.05）. The VAS score after 6 hours of postoperation was lower than that after every other time points（P0.05）. The discrepancy of Ramsay score among the 3 groups has no statistical significance after comparison（P0.05）. The incidence of nausea, vomiting, and throat discomfort in Group Ⅲ was higher than that in Group Ⅰ（P0.05）.The times of superaddition of analgesics in Group Ⅱ and Ⅲ was higher than that in Group Ⅰ（P0.05）. Conclusion： Dezocine in combination with dexamethasone is used for preemptive analgesia produce synergistic effect in laparoscopic cholecystectomy, they can prolong the time of postoperative analgesia, reduce the dose of analgesics and its side effects.