不同剂量地佐辛预防鼻道手术全身麻醉苏醒期不良反应的效果评价

Effect Evaluation of Different Dosages of Dezocine in Prevention of Adverse Reactions During Postoperative General Anesthesia Revival Period after Nasal Surgery

目的探讨不同剂量地佐辛对鼻道手术全身麻醉苏醒期不良反应的预防效果。方法选择2013年1—12月在我院于瑞芬太尼及七氟醚复合全身麻醉下择期行鼻内窥镜下鼻道手术60例,随机分为0.10、0.15和0.20 mg/kg地佐辛组各20例。手术结束前15 min,3组分别静脉注射地佐辛0.10、0.15和0.20 mg/kg。记录各组呼吸恢复时间、睁眼时间、拔管时间及麻醉前(T0)、拔管前(T1)、拔管时(T2)、拔管后10 min(T3)、拔管后30 min(T4)、拔管后60 min(T5)的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(Sp O2),并于拔管时进行拔管咳嗽评分,拔管后5 min采用镇静-躁动评分法(SAS)和视觉模拟评分法(VAS)对躁动和疼痛情况进行评分。结果 3组睁眼时间、拔管时间随着地佐辛浓度增高逐渐延长,SAS评分随着地佐辛浓度增高逐渐降低,组间比较差异均有统计学意义(P<0.05);拔管咳嗽评分随着地佐辛浓度增高逐渐降低,0.20 mg/kg地佐辛组与0.10及0.15 mg/kg地佐辛组比较差异有统计学意义(P<0.05);VAS评分随着地佐辛浓度增高逐渐降低,0.15及0.20 mg/kg地佐辛组与0.10 mg/kg地佐辛组比较差异有统计学意义(P<0.05)。T1、T2、T3时3组MAP均较T0时升高,差异均有统计学意义(P<0.05);T1、T2、T3时3组随着地佐辛浓度增高MAP逐渐降低,组间比较差异均有统计学意义(P<0.05)。T1、T2时3组HR均较T0时升高,差异均具有统计学意义(P<0.05);T1、T2时3组随着地佐辛浓度增高HR逐渐降低,0.20 mg/kg地佐辛组与0.10及0.15 mg/kg地佐辛组比较差异有统计学意义(P<0.05)。3组间各时间点Sp O2变化不大,差异均无统计学意义(P>0.05)。结论在瑞芬太尼及七氟醚复合全身麻醉下行鼻道手术,手术结束前15 min静脉注射地佐辛0.15 mg/kg可起到良好镇痛作用,并可减轻患者全身麻醉苏醒期心血管应激反应,抑制拔管时呛咳,减少躁动。

Objective To observe the effects of different dosages of Dezocine in prevention of adverse reactions during postoperative general anesthesia revival period after nasal surgery. Methods A total of 60 patients undergoing nasal surgery under general anesthesia from Remifentanil and Sevoflurane were selected from our hospital during January to December2013 and were divided randomly into 3 groups（0. 10,0. 15,and 0. 20 mg / kg Dezocine groups）,with 20 patients in each group. 15 minutes before the end of surgery,intravenous Dezocine was injected to the three groups in the units of 0. 10,0. 15,0. 20 mg / kg respectively. Recovery time of spontaneous breathing,eye opening time,extubation time,before anesthesia（T0）,before extubation（T1）,extubation（T2）,10 min after extubation（T3）,30 min after extubation（T4）,60 min after extubation（T5）,mean arterial pressure after extubation（MAP）,heart rate（HR）,pulse oximetry（Sp O2） were observed.Cough score was recorded at extubation time,and SAS,VAS for agitation and pains were observed 5 min after extubation. Results The eye opening time and extubation time were elongated gradually as the increase concentration of Dezocine in the 3groups but the SAS score decreased with increasing concentration along with the concentration increase of Dezocine. The differences between the 3 groups were statistically significant（P〈 0. 05）. Cough score was decreased sequentially along with the concentration increase of Dezocine in the 3 groups,and 0. 20 mg / kg Dezocine group was compared with 0. 10,0. 15 mg / kg Dezocine group with significant difference（P〈 0. 05）. The VAS was reduced sequentially along with increasing concentration of Dezocine in the 3 group,and 0. 15,0. 20 mg / kg Dezocine group was compared with 0. 10 mg / kg Dezocine group with significant difference（P〈 0. 05）. MAP in the three groups was higher in T1,T2 and T3 than that in T0. MAP gradually decreased in T1,T2,T3 along with the increasing concentration of Dezocine,and the difference was statistically significant（P〈 0. 05）. The HR in the three groups was higher in T1,T2 than that in T0,and the difference was statistically significant（P〈 0. 05）. HR gradually decreased in T1,T2 along with the increasing concentration of Dezocine,and 0. 20 mg/kg Dezocine group was compared with 0. 10,0. 15 mg / kg Dezocine group with significant difference（P〈 0. 05）. Sp O2 in the 3groups did not show difference of statistical significance（P〈 0. 05）. Conclusion In nasal surgery under general anesthesia from Remifentanil and Sevoflurane,intravenous Dezocine in the unit of 0. 15 mg / kg can effectively reduce pain,cardiovascular stress reaction,extubation cough and agitation 15 minutes before the end of surgery.