地佐辛术毕前应用对妇科腹腔镜手术患者复苏期及术后疼痛的影响

Influence of dezocine used before end of operation on recovery and postoperative pain

目的：观察术毕前应用地佐辛对妇科腹腔镜手术患者术后复苏的影响及对术后疼痛干预效果。方法将择期腹腔镜下行全子宫切除术患者60例，ASAⅠ～Ⅱ级，分为观察组（应用地佐辛，n＝30）和对照组（应用生理盐水，n＝30）。瑞芬太尼复合丙泊酚静脉气管内插管全身麻醉，术毕前30～40 min观察组静脉注射地佐辛0．1 mg/kg （生理盐水稀释至10 mL ），对照组注射同容量生理盐水。记录两组患者诱导前、注药后及苏醒前、后的血压、心率（H R ）变化，以及复苏时间、复苏期不良反应及术后疼痛发生情况。结果观察组患者苏醒期时的平均动脉压（MAP）升高、HR增快幅度低于对照组（P＜0．05）；两组患者恢复自主呼吸时间与拔管时间比较，差异无统计学意义（P＞0．05）。两组患者苏醒期氧分压（PO2）、二氧化碳分压（PCO2）、血氧饱和度（SaO2）比较，差异无统计学意义（P＞0．05）；观察组患者术后躁动-镇静评分（PASS）、视觉模拟评分（VAS）明显低于对照组（P＜0．05），寒战发生率也低于对照组（P＜0．05）。结论妇科腹腔镜手术患者术毕前静脉应用地佐辛，能有效抑制患者苏醒期的心血管应激反应，不影响复苏速度，且能减少苏醒期躁动和术后疼痛。

Objective To observe the influence of dezocine used before end of operation on postoperative recovery and its inter-vention effect on postoperative pain in the patients with gynecological laparoscopic operation .Methods 60 patients（ASA Ⅰ - Ⅱ ） scheduled hysterectomy operation by gynecological laparoscopy were randomly divided into the observation group （dezocine group , n=30） and the control group（normal saline group ,n=30） .Remifentanil combined with propofol was intravenously given for con-ducting endotracheal intubation general anesthesia .The observation group was given dezocine 0 .1mg/kg（diluting to 10mL by nor-mal saline） at 30-40 min before the end of operation ,while the control group was given the same volume of physiological saline . Blood pressure ,heart rate（HR） ,recovery time ,adverse reactions during the recover period and postoperative pain before induction , after injection and before recovery were recorded .Results The elevation of mean arterial pressure（MAP） and the increase of HR during the recovery period in the observation group were lower than those in the control group （P＆lt;0 .05）;the recovery time of au-tonomous respiration and extubation time had no statistical difference between the two groups （P＆gt;0 .05） .PO2 ,PCO2 and SaO2 had no statistical difference between the two groups （P＆gt;0 .05）;the postoperative agitation-sedation scores（PASS） and the visual ana-logue scale（VAS） scores in the observation group were significantly lower than those in the control group （P＆lt;0 .05） ,and the oc-currence rate of chills also was lower than that in the control group （P＆lt;0 .05） .Conclusion Intravenous dezocine before the end of operation in the gynecological laparoscopic operation can effectively inhibit the cardiovascular stress reaction ,does not affect the re-covery speed ,moreover can decrease the restlessness during the recovery period and postoperative pain .