地佐辛超前镇痛对面肌痉挛术后麻醉苏醒期的影响

The effect of dezocine preemptive analgesia on hemifacial spasm postoperative anesthesia recovery period

目的探讨地佐辛超前镇痛对显微血管减压术（microvasculardecompression，MVD）治疗面肌痉挛苏醒期的影响。方法32例择期行MVD治疗面肌痉挛手术患者，按随机数字表法分为实验组（I组）和对照组（Ⅱ组），每组16例：I组术毕前30min静注5mg，2ml地佐辛；Ⅱ组术毕前30min静注2ml生理盐水。观察术后苏醒时间、拔出喉罩后10min疼痛视觉模拟评分（visualanaloguescale，VAS）、Ramsay镇静评分及拔出喉罩即刻躁动评分（rikeragitation-sedationscale，RSS）及麻醉前（T0，基础值）、拔出喉罩前5min（T1）、拔出喉罩即刻（T2）、拔出喉罩后10min（T3）时平均动脉压meanarterialpressure，MAP）、心率（heartrate，HR）、脉搏血氧饱和度（pulseoxygensaturation，SpO2）。结果术后苏醒时间、Ramsay镇静评分，I组与Ⅱ组之间差异无统计学意义（P〉0．05）；I组与Ⅱ组之间在T：RSS评分[（0．62＋0．11），（2．83＋0．24）分]及在T，VAS评分[（1．04＋0．22），（3．30±0．41）分]之间比较差异有统计学意义（P〈0．05）；MAP、HR，I组与Ⅱ组之间T0和T。差异无统计学意义（乃O．05），I组T2和T3MAP[（96．6±1．1），（94．7±1．1）mmHg（1mmHg=0．133kPa）]、HR[（81．4±1．7），（78．0±1．2）次／min]与Ⅱ组T2和T3MAP[（104．9±1．5）、（100．9±1．2）mmHg]、HR[（87．7±2．0）、（85．0±1．9）次／min]比较，差异有统计学意义（P〈0．05）。II组内T2和BMAPl（104．9±1．5）、（100．9±1．2）mmHg]、HR[（87．7±2．0）、（85．0±1．9）次／min]与ToMAPl（95．5±2．0）mmHg]、HR[（81．8±2．6）次／min]比较，差异有统计学意义（P〈0．05），pO2两组比较差异无统计学意义（P〉0．05）。两组患者在苏醒期阶段均无发生呼吸抑制、恶心呕吐、畏寒发热等并发症。结论地佐辛超前镇痛能够有效减轻MVD治疗面肌痉挛苏醒期的疼痛、降低拔喉罩即刻躁动发生率及维持苏醒期血流动力学的稳定。

Objective To explore effect of dezocine preemptive analgesia on microvascular decompression （MVD） for hemifacial spasm in anesthesia recovery period. Methods Thirty-two patients, who underwent the MVD for hemifacial spasm, were randomly divided into experimental group （group I ） and control group （group I[ ） with 16 patients per group. In group I , patients received intravenous injection of dezocine 5 mg/2 ml 30 min before the end of the surgery. While in group II , patients received intravenous injection of saline 2 ml 30 min before the end of the surgery. Postoperative recovery time, pain visual analogue scale （VAS） 10 rain after extubation and pulling out laryngeal mask immediately riker agitation-sedation scale （RSS） were assessed. Mean arterial pressure （MAP）, heart rate （HR） and pulse oxygen saturation（SpO2） were observed before anesthesia （To, baseline）, 5 min before pulling out the laryngeal mask （Tl）, extracting the laryngeal mask immediately （TO） and 10 min after pulling out the laryngeal mask（T3）. Results There was no significant difference in postoperative recovery time and Ramsay sedation score between group I and group II （P〉O.05）. Significant difference between group I and group II in RSS score at T2 [（0.6±0.1）, （2.8±0.2） points] and VAS score at T3 [ （1.0±0.2）, （3.3±0.4） points] were observed. There was no significant difference in MAP and HR at To and T1 between group I and group I1 （P〉O.05）. From our results, it showed significant differences between group I in MAP[ （96.6±1.1）, （94.7±1.1） mmng（1 mmHg--O.133 kPa）], HR[（81.4±1.7）, （78.0±1.2） bpm] and group II in MAP[ （104.9±1.5）, （100.9±1.2） mmHg], HR[（87.7±2.0）, （85.0±1.9） bpm] at T2 and T3. The MAP[（95.5±2.0） mmHg] and HR[（81.8±2.6） bpm] at To were compared with T2 and T3 in MAP[（104.9±1.5）, （100.9±1.2） mmHg], HR[（87.7±2.0）, （85.0±1.9） bpm] in group lI, which showed significant difference （P〈0.05）. There was no significant difference in SpO2 （P〉0.05）. No differences were observed in the complications in recovery stage, such as respiratory depression, nausea and vomiting, chills and fever between the two groups. Conclusions Dezocine for preemptive analgesia can effectively relieve postoperative pain, reduce the incidence of pulling laryngeal mask immediately agitation and maintain hemodynamic stability in the recovery period of patients with MVD for hemifacial_ spasm.