地佐辛超前镇痛对腹腔镜子宫全切术苏醒期躁动的临床影响

Protective effect of Dezocine for preemptive analgesia on agitation during recovery period in laparoscopic hysterectomy

目的：观察地匠辛超前镇痛对腹腔镜子宫全切术患者苏醒期躁动及心血管的影响。方法：择期行腹腔镜子宫全切术的患者60例，ASAl或Ⅱ级，随机数字表法分为地匠辛超前镇痛组，即观察组（D组）和对照组（C组），每组30例。所有患者静脉麻醉，术中采用丙泊酚4～6mg／（kg-h）瑞芬太尼6～8斗g／（kg·h）。D组患者手术结束前30min静脉注射地匠辛5mg，C组患者则静注生理盐水lml。记录并比较两组患者术后苏醒时间，拔出喉罩后10min Prince-henry疼痛评分，拔出喉罩即刻躁动sAs评分及麻醉前（T0基础值）、拔出喉罩前5min（T1）。拔出喉罩即刻（T2），拔出喉罩后10miz（T3）时平均动脉压（MAP）、心率（ⅡR）、血氧饱和度（SPO2）。结果：两组患者在术后苏醒时间、MAP、ⅡR、T0、T1、SpO2方面比较差异均无统计学意义（P〉0．05）；两组患者的T2SAS评分及在T3 Prince-henry评分、T2和T3MAP、ⅡR比较差异有统计学意义（P〈0．05）；C组内T2和T3MAP、ⅡR与T0MAP、儿R比较差异有统计学意义（P〈0．05）。两组患者在苏醒期都未发生呼吸抑制，恶心呕吐等并发症。结论：地匠辛超前镇痛可有效降低腹腔镜子宫全切术中全麻患者苏醒期躁动，并能降低患者拔管期心血管反应，不出现延长苏醒过程。

Objective： To evaluate effects of Dezocine preemptive analgesia in preventing agitation during recovery period and reducing cardiovascular events in laparoscopic hysterectomy. Methods： Sixty patients, undergoing laparoscopic hysterectomy, ASA I or Ⅱ, were randomly divided into observation group （group D, 30 cases） and control group （group C, 30 cases） according to random digits table. Group D was applied 5rag Dezocine tor preemptive analgesia 30rain betore the end of operation, while group C was given normal saline hnl. All patients received total intravenous anesthesia by Propotol 4-6rag/（ kg · h） and Remitentanil 6 - 8ptg/（ kg ~ h） in the operation. Postoperative recovelT time, Prince-hemT pain score 10rain after extubation, and pulling out the laryngeal mask im- mediately SAS score were recorded. Mean arterial pressure （MAP）, heart rate （HR） and oxygen saturation （Sp02） betore anesthesia （To, baseline）, 5rain betore pulling out the laryngeal mask （T,）, extracting the laryngeal mask immediately （T2 ） and 10min after pulling out the laryngeal mask （ T3 ） were observed. Results ： There was no significant difference in postoperative recovelT time between group C and group D （P〉0.05）. It showed significant difference between group C and group D in SAS score at T2 and prince-hemT score at T3. There were no significant differenees in MAP and HR at T0 and TI between group C and group D （ P〉0.05 ）. It showed significant differences between MAP and HR at T2 and T3 and MAP and HR at T0 in group C （ P〈0.05 ）. The complications in recover- y stage, such as respiratory depression, nausea and vomiting, were not observed in the two groups. Conclusions： Dezocine preemptive analgesia can effectively reduce the agitation during the recovery period and extubation cardiovascular reaction of the patients in laparo- scopic hysterectomy, and dose not prolong the recovery process.