不同时间点应用地佐辛对腹腔镜胆囊切除术后的镇痛效果

Outcome of dezocine injection for postoperative analgesia in patients undergoing laparoscopic gallbladder surgery at different time points

目的 观察与比较不同超前镇痛时点应用地佐辛对腹腔镜胆囊切除术后镇痛的作用效果。方法 选择Ⅰ~Ⅱ级择期腹腔镜胆囊切除患者90例,按双盲随机原则分为3组：地佐辛术后镇痛组（A组）,地佐辛超前镇痛组（B组）和对照组（C组）,每组30例。A组患者缝合皮肤前20 min静脉注射地佐辛10 mg;B组患者诱导前10 min静脉注射地佐辛5 mg,缝合皮肤前20 min静脉注射地佐辛5 mg;C组患者缝合皮肤前20 min静脉注射地佐辛5 mg。记录患者一般资料、麻醉时间及手术时间。记录患者麻醉苏醒时间。分别于术后1 h、3 h、6 h采用视觉模拟评分法（VAS）对切口疼痛进行评分。当患者VAS评分大于7分时,给予芬太尼1μg/kg以补救镇痛。记录三组患者术后使用芬太尼的时间、例数及次数和术后咽喉痛、恶心呕吐、头晕嗜睡及呼吸抑制等不良反应的发生率。结果 三组患者一般资料、麻醉时间及手术时间差异均无统计学意义（P〉0.05）。A、B两组VAS评分差异无统计学意义（P〉0.05）,但均低于对照组（P〈0.05）。B组患者麻醉苏醒时间明显短于A组（P〈0.05）;B、C两组患者麻醉苏醒时间差异无统计学意义（P〉0.05）。A组患者术后呼吸抑制的发生率明显高于B、C两组（P〈0.05）。结论 地佐辛在腹腔镜胆囊切除手术开始前应用5 mg和手术结束前应用5 mg能够缩短麻醉苏醒时间,有效缓解术后切口疼痛,减少术后镇痛药的使用量,且并发症较少,可提高术后镇痛效果。

Objective To investigate the outcome of dezocine injection for postoperative analgesia in patients undergoing laparoseopic gallbladder surgery at different time points. Methods According to the principle of double blind randomized, 90 patients scheduled to undergo laparoscopic gallbladder surgery were allocated into three groups： postoperative analgesia of dezocine injection group （Group A） , preemptive analgesia of dezocine injection group （Group B） and control group（ Group C） , 30 patients per group. Patients of Group A were injected intravenously with dezocine injection at a dose of 10 mg at 20 rain before sewing leather, patients of Group B were injected intravenously with dezocine injection at a dose of 5 mg at 10 min before anesthesia induction and 10 mg at 20 min before sewing leather, and patients of Group B were injected intravenously with dezocine injection at a dose of 5 mg at 20 min before sewing leather. General indexes of patients, duration of anesthesia and time to operation were recorded. Time of anesthesia awakening was recorded. Visual Analogue Scale/Score （VAS） was performed at 1 h,3 h and 6 h after surgery. Fentanyl at a dose of I p.g/kg was de- livered when VAS was greater than 7 scores. The use time and intervals of fentanyl, the cases of using fentanyl, and the incidence of adverse reactions such as sore throat, nausea and vomiting, dizziness, sleepiness and respiratory depression were determined after operation in the three groups of patients. Results There was no statistical significance in patients＇ general indexes, anesthesia time and time to operation （ P 〉 0. 05 ） between the three of groups. There was no statistical significance in VAS （ P 〉 0. 05 ） between Group A and Group B, but VAS of the two groups was both lower （ P 〈 0. 05 ） than that of Group C. Time of anesthesia awakening of Group B was significantly shorter （ P 〈 0.05 ） than that of Group A, however, there was no statistical significance in time of anesthesia awakening （P 〉 0. 05 ） between Group B and Group C. The incidence of respiratory depression of Group A after operation was higher （P 〈 0. 05 ） than those of Group B and Group C. Conclusion Dezocine at a dose of 5 mg before laparoscopic gallbladder surgery started and at a dose of 5 mg before surgery finished can shorten time of anesthesia awakening, relieve effectively postoperative incision pain, reduce postoperative analgesics used, have fewer postoperative complications, and improve the effect of postoperative analgesia.