地佐辛在子宫全切术后静脉镇痛的临床研究

Clinical study of patient-controlled intravenous analgesia with dezocine after laparoscopic assisted vaginal hysterectomy

目的:研究地佐辛用于腹腔镜辅助下阴式子宫全切术后静脉自控镇痛时的镇痛效果与不良反应。方法:选择ASAⅠ～Ⅱ级,行腹腔镜辅助下阴式子宫全切手术患者90例,随机分为3组,每组30例。S组:舒芬太尼2.0μg/kg;DS1组:地佐辛0.2 mg/kg联合舒芬太尼1.5μg/kg;DS2组:地佐辛0.2mg/kg联合舒芬太尼1.0μg/kg,3组均加托烷司琼10 mg,用生理盐水配成100 ml静脉镇痛。比较3组术后不同时点的视觉模拟评分法(VAS评分)、Ramsay镇静评分、病人自控性镇痛(patient-controlled analgesia,PCA)泵的不良反应的发生率。结果:DS2组术后各时点的VAS评分均高于DS1组及S组(P<0.05);与DS1组比较,S组术后8 h及16 h的Ramesay镇静评分均升高(P<0.05);S组中的恶心发生率高于DS2组(P<0.05)。结论:地佐辛0.2 mg/kg联合舒芬太尼1.5μg/kg用于腹腔镜辅助下阴式子宫全切术后静脉自控镇痛时的镇痛效果明显,且不良反应发生率较低。

Objective： To observe the analgesia and side-effects of patient-controlled intravenous analgesia（PCIA） with dezocine combined with sufentanil after laparoscopic assisted vaginal hysterectomy and discussed more appropriate analgesic dose of dezocine.Methods： Selected ASA Ⅰ~Ⅱ,90 patients of laparoscopic assisted vaginal hysterectomy were randomly divided into 3 groups.Each group included 30 patients.S Group： sufentanil 2.0 μg/kg;DS1 Group： dezocine 0.2 mg/kg combined with sufentanil 1.5 μg/kg;DS2 Group： dezocine 0.2 mg/kg combined with sufentanil 1.0 μg/kg,which were combined with tropisetron 10 mg for intravenous analgesia.The VAS score,Ramsay sedation score,the ratio of nausea and vomitting were recorded.Results： The VAS score of DS2 group at each time point were higher than DS1 and S group（P0.05）.The VAS score of DS1 Group at each time point were higher than S group,but the difference was not statistically significant（P0.05）.The Ramsay sedation score of S group at 8 h and 16 h after operation were higher than DS1 group（P0.05）.The ratio of nausea and vomiting of S group were higher than DS1 group（P0.05）.Conclusion： 0.2 mg/kg dezocine combined with 1.5 μg/kg sufentanil for intravenous analgesia after laparoscopic assisted vaginal hysterectomy is more effective, lower incidence of adverse reactions and a relatively safe and effective technique for intravenous analgesia.