地佐辛辅助硬膜外麻醉在妇科腹腔镜手术中的应用

The safety and feasibility of dezocing in gynecological laparoscopy under epidural anesthesia

目的:探讨地佐辛辅助硬膜外麻醉在妇科腹腔镜手术中应用的可行性。方法:选择硬膜外麻醉下行妇科腹腔镜手术患者60例,ASAⅠ～Ⅱ级,年龄18～55岁,手术时间均不超过两个小时,随机均分为地佐辛组(D组)和芬太尼组(F组)。记录给药前(T0)、给药后10min(T1)、气腹后即刻(T2)、气腹后30min(T3)、气腹后60min(T4)、气腹消除后5min(T5)的呼气末二氧化碳分压(PETCO2)及Ramsay镇静评分。观察两组患者出现恶心、呕吐、寒颤、呼吸抑制(呼吸频率低于8次/min或脉搏血氧饱和度(SpO2)低于90%)等不良反应的发生率。结果:两组患者的Ramsay镇静评分无统计学差异,T3、T4时点D组PETCO2低于F组(P<0.05),恶心、呕吐、呼吸抑制的发生率F组明显高于D组。结论:地佐辛比较芬太尼更适合用于辅助硬膜外麻醉行妇科腹腔镜手术,能消除人工气腹的不适,达到镇痛镇静完全及不良反应少的麻醉效果。

To investigate the safety and feasibility of dezozine in gynecological lapa- raoscopy under epidural anesthesia. METHODS： Sixty ASAⅠor Ⅲ patients, aged 18-55 yr, under- going gynecological laparoscopy surgery, were randomly divided into 2 groups （n=30 each）： Dezocing group （group D） and Fentanyl group （group F）. PETCO2 and Ramsay sedation scales were recorded at the time points followed： pre- anesthesia （To）, 10 rain after administration （T1）, instantly after pneumoperitoneum （T2）, 30 min （T3） and 60 rain （T4） after pneumoper- itoneum, 5 rain after eliminating pneumoperito- neum （Ts）. The incidences of side effects such as nausea, vomiting, algor and respiratory de- pression was observed. RESULTS：Ramsay seda-tion scales were not statistically different be- tween the two groups. D group＇s P^T CO2 was lower than of F group at the time points of T3 and T4. The incidences of nausea, vomiting and respiratory depression were higher in F group （P〈0.05）. CONCLUSION： Dezocine has signif- icant advantages over fentanyl to assist epidural anesthesia in gynecological laparoscopy with re- spect to reduce discomfort during pneumoperito- neum, better analgesia and sedation, less side effects.