不同剂量地佐辛与罗哌卡因联合超前镇痛应用于腹腔镜子宫切除术后镇痛的效果观察

Effect Observation of Different Dosages of Ropivacaine Dezocine Combined with Preemptive Analgesia in Laparoscopic Hysterectomy Postoperative Analgesia

目的比较不同剂量地佐辛联合罗哌卡因超前镇痛应用于腹腔镜子宫切除术后镇痛的效果。方法选择2011年1月至2012年1月在怀来县中医医院就诊的90例择期腹腔镜子宫切除患者进行完全随机分为A组、B1组和B2组,每组各30例。妇科腹腔镜手术结束前30 min子宫切除后残端缝合时,A组静脉滴注地佐辛0.2 mg/kg、B1组地佐辛用量为0.1 mg/kg、B2组地佐辛用量0.15 mg/kg;另B1、B2两组且均在切皮前切口周围0.5%罗哌卡因阻滞、术毕拔套管时盆腔喷洒0.25%罗哌卡因15 mL;并分别在术后的0.5、2、6、12、24 h记录患者在安静和咳嗽状态下的视觉模拟评分,记录术后自主呼吸恢复、拔管时间、苏醒期躁动程度例数、麻醉性镇痛药的使用情况、术后镇痛和不良反应情况。结果 A组、B1、B2组术后疼痛差异具有统计学意义(P<0.05);B1、B2组患者手术时间及拔管时间均无统计学意义(P<0.05);三组术后拔管期躁动发生率无统计学意义。术后三组恶心、呕吐发生率差异无统计学意义(P>0.05)。结论妇科腹腔镜子宫切除术应用地佐辛0.1 mg/kg联合罗哌卡因超前镇痛安全有效、不良反应少,小剂量应用对术后苏醒影响小且可减少术后躁动。

Objective To compare the effects of different dosages of ropivacaine dezocine combined with preemptive analgesia in laparoscopic hysterectomy postoperative analgesia.Methods 90 patients were d randomly divided into Group A,Group B1 and Group B2 with 30 patients in each group.30 minutes before laparoscopic gynecologic operation with the hysterectomy stump suture,Group A received intravenous injection of dezocine 0.2mg/kg;Group B1 dezocine dosage 0.1mg/kg;Group B2 dezocine dosage 0.1mg/kg;while the two groups of B1 and B2 were sprayed with 0.5% ropivacaine around the cut before skin incision for blocking and 15ml of 0.25% ropivacaine before pulling the sleeve after pelvic operation;and the VAS scores after 0.5,2,6,12,24 hours were recorded in quiet and cough state,the recovery of postoperative spontaneous breathing extubation time,number of cases of the restlessness,restlessness of the situation of narcotic analgesics used,postoperative analgesia and adverse reaction of nausea and vomiting cases were recorded.Results Observed in a quiet state,compound medication on incision and abdominal pain of the two groups were good,the score of VAS4,no statistical significant difference（P0.05）;postoperative nausea,vomiting occurrence rate of two groups were not statistically significantly different（P0.05）.Postoperative extubation time was not statistically significant.Postoperative agitation incidence rate of three groups were not statistically significant.Group A and Group B pain after 2-6 hours of surgery had significant difference（P0.05）.Conclusion Application of dezocine 0.1mg/kg joint Ropivacaine preemptive analgesia in gynecologic laparoscopic hysterectomy is safe and effective with few side effects;the application of small dose has small effect on postoperative recovery and can reduce postoperative agitation.