地佐辛用于鼻内窥镜手术的临床观察

Clinical observation of dezocine application in endoscopic sinus surgery

目的:观察地佐辛用于鼻内窥镜手术患者全身麻醉的临床效果。方法:ASA(美国麻醉医师协会)I或Ⅱ级择期鼻内窥镜手术60例,随机分为地佐辛组(D组)和芬太尼组(F组)各30例。入手术室后,两组均用5 s时间经外周静脉分别静脉注射0.12 mg/kg地佐辛或1.2μg/kg芬太尼,60 s后复合相同药物进行诱导、插管。记录两组入室时(T0)、达到插管条件时(T1)、插管时(T2)、插管后1 min(T3)、插管后4 min(T4)、插管后7 min(T5)各时点MAP(平均动脉压)、HR(心率)和注药后60 s内有无呛咳发生及苏醒时间、苏醒期躁动评分。结果:与T0比较,两组组内T1 MAP、HR下降,两组组内T2、T3、T5 MAP、HR上升,两组组内T4 MAP下降有显著差异(P<0.05);与T1比较,两组组内T2、T3 MAP、HR上升有显著差异(P<0.05);组间比较,两组各时点MAP、HR无显著差异(P>0.05)。两组患者注药后60 s内均无呛咳发生,两组患者苏醒期躁动评分0分比较有显著差异(P<0.05),两组患者苏醒时间无显著差异(P>0.05)。结论:静脉注射0.12 mg/kg地佐辛或1.2μg/kg芬太尼均无呛咳发生,复合相同药物用于鼻内窥镜手术诱导两组插管前后血流动力学变化相似、术后苏醒均较快,但前者全麻苏醒期躁动较少。

Objective ： To observe the clinical effect of dezocine in general anesthesia of endoscopic sinus surgery. Methods ： 60 who suffered from I or H ASA and underwent endoscopic sinus surgery were randomly assigned into dezocine group （ D group） and Fentanyl group （F group） ,each of 30 cases. The patients in two groups were intravenously injected with 0.12 mg/kg dezocine or 1.2 fl.g/kg fentanyl by peripheral venous route for 5 second. After 60 seconds, combine the same complex medicines to induce the anesthesia and insert the tube. Record MAP and HR of two group at the time of entry operation room （T0）, ready for intubation （T1）, the time of intubation （T2）, lmin after intubation （T3）, 4 min after intubation （T4） , 7min after intubation and the oc- currence of cough in 60 sec after injection, the awake time, agitation scores during the awake period. Results： Compare with TO, MAP and HR at T1 of both two group decreased, MAP and HR at T2, 13 and 15 of both two group increased, MAP at T4 of both two group decreased and the difference had statistical significance （P 〈 0.05 ） ; Compare with T1, MAP and HR at T2, T3 of both two group increased with statistical significance （ P 〈 0.05 ） ; compared between two groups, there were no significant difference of MAP and HR at each time point （P 〉 0.05 ）. There was no cough occurred in 60sec after injection among the patients of two groups. Compared the agitation scores in awake period, there were significant differences between two groups at 0 degree （P 〈 0.05）. There was no significant difference of awakening time between two groups （P 〉 0.05 ）. Conclusion ： There was no cough occurred after iv injection of 0.12 mg/kg dezocine and 1.2 ~g/kg fentanyl. The hemodynamical changes of post - incubation com- pared to pre - intubation were similar between the applications of two medicines combined with same complex medicines in general anesthesia of endoscopic sinus surgery. Patients treated with two medicines all recovered from anesthesia rapidly. However, there was less emergence of agitation in awaking period treated by dezocine than that of fentanyl.