地佐辛注射液对全麻苏醒期躁动及疼痛的影响

Effect of dezocine injection on pain and emergence agitation during recovery from general anesthesia

目的探讨地佐辛注射液静脉镇痛对全麻苏醒期患者躁动及术后疼痛的治疗效果。方法选择90例择期行腹腔镜胆囊切除术患者,随机均分为3组:地佐辛组(Ⅰ组,男15例,女15例)、曲马朵组(Ⅱ组,男16例,女14例)、对照组(Ⅲ组,男17例,女13例)。患者均用咪达唑仑+丙泊酚+舒芬太尼+顺式阿曲库铵静脉诱导后行气管插管。术毕关气腹时Ⅰ组以地佐辛0.1mg/kg,Ⅱ组以曲马朵2mg/kg,Ⅲ组以生理盐水1ml静脉注射。采用疼痛视觉模拟评分法(VAS)、躁动评分及镇静评分法,分别记录各组患者拔管后0.5、1、4、12、24h的镇痛评分,以及拔管即时、拔管后5、10、30、60min的躁动评分及镇静评分。结果Ⅰ组和Ⅱ组在拔管后0.5、1、4、12h时点的VAS评分明显低于Ⅲ组(P<0.05),在 24h时点各组VAS评分差异无统计学意义(P>0.05);Ⅰ组在4h时点VAS评分低于Ⅱ组(P<0.05),其余时点两组间差异无统计学意义(P>0.05);从拔管即时到拔管后30min各时点,Ⅰ组对躁动的控制效果和镇静效果均显著强于Ⅱ组和Ⅲ组。结论地佐辛注射液对腹腔镜胆囊切除患者苏醒期躁动有良好的防治作用,镇痛明确,用于术后镇痛安全有效。

Objective To explore the effect of dezocine injection on emergence agitation during recovery from general anesthesia and post-surgical pain relief. Methods A total of 90 patients who underwent laparoscopic cholecystectomy were randomly divided into the dezocine group（group Ⅰ,15 men and 15 women）,tramadol group（group Ⅱ,16 men and 14 women）,and the control group（group Ⅲ,17 men and 13 women）.All patients were subjected to tracheal intubation after intravenous induction with midazolam,propofol,sufentanil,and cisatracurium.Groups Ⅰ,Ⅱ,and Ⅲ were intravenously injected with 0.1mg/kg dezocine, 2mg/kg tramadol,or 1ml of normal saline,respectively,after surgery and release of the pneumoperitoneum.The pain visual analog scale（VAS）,agitation score,and sedation score were used to record the visual analogue scores at 0.5,1,4,12,and 24h after extubation in all groups.The agitation scores and sedation scores at the time of extubation and at 5,10,30,and 60 min after extubation were also recorded.Results The VAS scores of groups Ⅰ and Ⅱ were much lower than those of group Ⅲ at 0.5,1,4,and 12h after the operation（P0.05）.The differences among the VAS scores of all groups 24h after the operation were not statistically significant （P0.05）.The VAS scores of group Ⅰ was lower than those of group Ⅱ within 4 hours after the operation（P0.05）.The difference in the VAS scores between the two groups at other time points（P0.05） were not statistically significant.The effects of control and sedation on emergence agitation in group Ⅰ were significantly higher than those in groups Ⅱ and Ⅲ at all time points upon extubation until 30 min after extubation.Conclusion Dezocine effectively and safely prevents agitation on waking during recovery and post-surgical pain relief among patients undergoing laparoscopic cholecystectomy.