地佐辛复合丙泊酚对腹式子宫切除术牵拉反应的预防作用

Prevention of intra operative dragging reaction during hysterectomy by dezocine combined with propofol

目的研究地佐辛复合丙泊酚对腹式子宫切除术牵拉反应的预防作用。方法选择择期行腹式子宫切除术患者60例（ASA I-Ⅱ级）,随机分成三组。所有患者给予腰麻,麻醉平面调节并固定于T6后,给予A组患者0.1 mg/kg地佐辛,静脉注射;B组静脉注射0.1 mg/kg地佐辛后丙泊酚持续泵注2-4 mg/（kg·h）;C组单次静注丙泊酚1.5 mg/kg后持续泵注2-4mg/（kg·h）。记录麻醉前（T0）、腰麻平面固定后（T1）、静注药物后5min（T2）、切皮（T3）、牵拉子宫时（T4）、术毕（T5）患者的HR、MAP及Ramesay镇静评分;评价肌松效果、牵拉反应、患者舒适度及满意度。结果三组患者一般情况无差异（P〉0.05）;与T0相比,Ⅲ组T2及T5时刻MAP与T0相比差异有统计学意义（P〈0.05）,T2、T3、T4及T5时刻HR与T0相比差异有统计学意义（P〈0.05）;与T0相比,Ⅱ组及Ⅲ组Ramesay镇静评分在T2、T3及T4时刻均升高,差异有统计学意义（P〈0.05）;Ⅱ组及Ⅲ组Ramesay镇静评分在T2、T3及T4时刻高于I组,差异有统计学意义（P〈0.05）。牵拉反应评价I组评为优的患者个数明显少于II组及III组,评为良及差的患者个数多于II组及III组,此差异有统计学意义（P〈0.05）;II组及III组舒适度及满意度评定为优的患者个数明显多余I组,差异有统计学意义（P〈0.05）。结论 0.1 mg/kg地佐辛复合丙泊酚可以很好预防腹式子宫切除手术中的牵拉反应,提高患者舒适度和满意度。

Objective To observe whether dezocine combined with propofol can prevent intra operative dragging reaction during hysterectomy or not. Methods Sixty patients （ ASA Ⅰ - Ⅱ ） which through hysterectomy surgery were randomly arranged to 3 groups. All the patients were under spinal anesthesia, adjusted the anesthesia plane to T6. Group 1： dezocine 0. 1 mg/kg were intravenous injected, Group ll： dezocine 0. 1 mg/kg were intravenous injected and then propofol 2 -4 mg/kg/h were intravenous pumped, Group 111： propofol 1.5 mg/kg were intravenous injected and then propofol 2 -4 mg/kg/h intravenous were pumped. HR 、 MAP and Ramesay scale were recorded at the time points of pre-anesthesia （T0 ）, pre-injection （T1）, 5 min after injection （T2 ）, skin incision （ T3 ）, dragging uterus （T4）, after surgery （T5 ）, the effect of muscle relaxation and the reaction of patients were recorded in the mean time, comfort degree and satisfaction degree of patients were evaluated after surgery. Results There was no significant difference of general condition between the three groups （P 〉 0. 05）. At the time point of T2 and T5 , MAP of Group 111 patients were significant lower than the base value （P 〈 0. 05 ）. At the time point of T2 , T3 , T4 and Ts , HR of Group 111 patients were significant lower then base value （P 〈 0. 05）. Dragging reaction during the surgery were significant reduced in Group 11 and Group 111 but not in Group 1 （ P 〈 0. 05 ）. Group 11 and Group 111 patients felt more comfortable and more satisfied than Group 1 patients （P 〈 0. 05）. Gonclusion 0. 1 mg/kg dezocine combined with propofol can pre- vent intra operative dragging reaction and make patient feel more comfortable during hysterectomy.