地佐辛注药时机对腰椎内固定患者苏醒期的影响

Administer occasion of dizocine on quality of recovery during the lumbar vertebrae internal fixation

[目的]探讨腰椎内固定术全身麻醉患者地佐辛镇痛的最佳给药时机。[方法]90例ASAⅠ～Ⅱ级男性患者,全身麻醉下行腰椎间盘切除内固定术。随机分为三组,Ⅰ组于麻醉诱导前10 min,Ⅱ组于手术结束前1～1.5 h,Ⅲ组于手术结束前15～20 min,静注地佐辛0.1 mg/kg。比较三组患者意识恢复时间及意识状态评分、呼吸恢复时间、拔管时间、循环指标、疼痛评分、躁动等不良反应的发生情况。[结果]三组患者苏醒期循环功能稳定,Ⅲ组患者在麻醉恢复期HR、MAP、SpO2低于Ⅰ组和Ⅱ组(P<0.05);呼吸、意识恢复时间及气管拔管与PACU停留时间长于Ⅰ组和Ⅱ组(P<0.05)。Ⅰ组OAAS评分4分13例,5分17例;Ⅱ组4分6例,5分24例;Ⅲ组3分24例,4分6例(P<0.01)。Ⅰ组VRS评分4分14例,3分8例,2分5例,1分3例;Ⅱ组4分22例,3分6例,2分2例,Ⅲ组均为4分(P<0.01)。Ⅰ组RS评分0级19例,1级6例,2级3例,3级2例;Ⅱ组0级28例,1级2例;Ⅲ组0级30例(P<0.01)。[结论]手术结束前1～1.5 h应用地佐辛0.1 mg/kg镇痛效果佳,苏醒期躁动发生率低,无呼吸抑制及深度镇静的发生。

[ Objective] To find the best administer occasion of dezocine on quality of recovery during the lumbar vertebrae internal fixation. [ Methods] A total of 90 male patients with ASA I - II underwent lumbar disceetomy and vertebrae internal fixation under general anesthesia. All patients were randomized into three equally sized groups （ n = 30） . Patients were administered dizocine 0. 1 mg/kg 10min before the induction of general anesthesia （ group I ） , 60 - 90 min （ group I ）, 15 - 20 min （group IR ） before the end of the operation. Mean artery pressure, heart rate and SpO2 were recorded before extubation and 5 min, 10 min, 15 min and 30 min after extubation. The degree of pain, restlessness and conscience, the recovery time of con- science, respiration and extubation were observed. [ Results] All patients achieved satisfactory cardiovascular index during re- covery period. HR, MAP and SpO2 in group III were lower than those in other groups （P 〈 0. 05） . The recovery time of respi- ration, conscience, extubation and stay at PACU were longer （P 〈 0.05 ） . The incidence of restlessness and degree of pain were significantly higher in group I （P 〈 0.05 ） . But all patients in group III had 4 of VRS and 0 of RS （ P 〈 0. 05 ） . [ Conclu- sion] Administration of 0. 1 mg/kg dizocine before the end of operation can provide better analgesia and decrease restlessness, without producing inhibition of respiration and deep sedation during the period of extubation of general anesthesia on the lumbar vertebrae internal fixation.