地佐辛联合芬太尼用于高强度聚焦超声整体消融子宫肌瘤中的临床观察

Clinical observation of the application of dezocine combined with fentanyl in high intensity focused ultrasound in the treatment of uterine fibroids

目的观察地佐辛与芬太尼联合应用于高强度聚焦超声单次整体消融治疗子宫肌瘤中的可行性。方法将择期进行镇静镇痛下高强度聚焦超声整体消融治疗的子宫肌瘤患者160例随机分为A组(芬太尼+咪达唑仓)80例、B组(联合应用地佐辛+芬太尼+咪达唑仓)80例。用视觉模拟评分法(VAS)评价镇痛效果,监测记录治疗前(T0)、给药时(T1)、治疗开始时(T2)、给药后30min(T3)、治疗结束0h(T4)、治疗结束2h(T5)、治疗结束4h(T6)、治疗结束8h(T7)、治疗结束24h(T8)患者的生命体征变化情况,以及患者的疼痛评分、舒适度评分、镇静评分、镇痛药消耗量、不良反应。结果两组患者治疗中镇痛效果均确切可靠、各时点血压、心率、血氧饱和度、心电图变化均在正常范围内,A组患者的VAS评分及Ramsay评分较B组高,但差异无统计学差异(P>0.05);A组患者3例出现排尿困难、对症处理后好转,两组患者均无呼吸抑制反应发生,但B组患者镇痛不良反应发生率明显低于A组,患者满意率显著高于A组(P<0.05)。结论地佐辛联合芬太尼在高强度聚焦超声单次整体消融治疗子宫肌瘤中镇痛效果可靠,不良反应少,值得临床中推广使用。

Objective To observe the feasibility of combining dezocine with fentanyl in the application of single integral high in‐tensity focused ultrasound（HIFU）ablation of uterine fibroids .Methods One hundred and sixty patients with uterine fibroids trea‐ted by HIFU under conscious sedation were randomly divided into 2 groups（n=80）：group A with treatment combined fentanyl and midazolam and group B treated with combined dezocine ,fentanyl and midazolam .Analgesic effect was evaluated with visual analog scale （VAS） .Variation of patients′vital signs （blood pressure ,heart rate ,electrocardiogram ,oxygen saturation） ,pain scores ,com‐fort scores ,sedation scores ,analgesic consumption and side effects were recorded before treatment （T0 ） ,during drug delivery （T1 ） , at the beginning of the treatment（T2 ） ,30 minutes after drug delivery （T3 ） ,at the end of the treatment（T4 ） ,2 hours after treatment （T5 ） ,4 hours after treatment （T6 ） ,8 hours after treatment （T7 ）and 24 hours after treatment（T8 ） .Results Both groups showed reliable analgesic effects and vital signs of each time point were stable .VAS scores and Ramsay scores of group A were higher than those of group B ,but there was no statistical difference （P〉0 .05） .Three patients in group A showed dysuria and relieved after symptomatic treatment .No respiratory depression occurred in both groups .But compared to group A ,the incidence of the analgesic side effects of group B was significantly lower and patients satisfaction was significantly higher（P〈0 .05） .Conclusion The analge‐sic effects of dezocine combined with fentanyl are reliable in HIFU ablation of uterine fibroids with fewer side effects ,and could be worthy to be promoted in clinical use .