地佐辛超前自控静脉镇痛用于骶管麻醉下吻合器痔上黏膜环切术的临床观察

Effects of dezocine on patients controlled intravenous analgesia ahead of sacral anesthesia under PPH post-operation

目的：不同剂量的地佐辛超前自控静脉镇痛用于骶管麻醉下行吻合器痔上黏膜环切术（PPH）术后的效果观察。方法：120例ASAⅠ-Ⅱ级骶管麻醉下PPH患者。数字表法随机分为A、B、C组,每组40例。3组患者分别在骶管麻醉之后,扩肛前从静脉注射地佐辛0.1 mg·kg-1负荷剂量,接静脉自控镇痛泵（PCIA）。镇痛液中地佐辛含量A组为0.015 mg·kg-1·h-1,B组为0.020 mg·kg-1·h-1,C组为0.025 mg·kg-1·h-1,术中持续监测血压（MAP）、心率（HR）、血氧饱和度（SPO2）,记录手术后6,12,24,48 h疼痛视觉模拟评分（VAS）,Ramsay镇静评分及头晕、恶心、呕吐、瘙痒、尿潴留、呼吸抑制等不良反应。结果：3组之间MAP、HR比较：A组明显高于B组和C组,有显著性差异（P〈0.05）;B组与C组之间比较无显著性差异（P〉0.05）;3组之间SPO2比较无统计学差异（P〉0.05）。术后6,12,24,48 h VAS评分,B、C组明显低于A组,有显著性差异（P〈0.05）。术后6,12 h Ramsay镇静评分,B、C组明显高于A组,有显著性差异（P〈0.05）。3组全程均未发生呼吸抑制,且恶性呕吐、瘙痒、尿潴留总发生率无显著性差异（P〉0.05）,但C组头晕发生率明显高于A、B组,有显著性差异（P〈0.05）。结论：地佐辛0.020 mg·kg-1·h-1用于骶管麻醉下PPH手术后超前自控静脉镇痛效果较好,不增加不良反应发生率。

OBJECTIVE To observe effects of different doses of dezocine on patients controlled intravenous analgesia ahead of sacral anesthesia under PPH post-operation. METHODS A total of 120 cases of ASA Ⅰ - Ⅱ grade, scheduled for PPH operation on sacral anesthesia, were randomly divided into three groups using a random number table： group A, B and C, with 40 patients in each group. Patients in three groups were intravenously injected dezocine 0. 1 mg· kg-1 loading dose, connected with patient-controlled intravenous analgesia （PCIA） pump before putting in anus expander. Then, patients were intravenously injected 0. 015 mg·kg-1 ·h-1 , 0. 020 mg·kg-1 ·h-1 and 0. 025 mg·kg-1 ·h-1 dezocine in group A, B and C. Values of MAP, HR and SPO2 during operation, side effects such as nausea, dizziness and dyspnea were recorded 6, 12, 24 and 48 hours after operation. VAS and Ramsay scores post-operation were scored. RESULTS Values of MAP and HR in groups A were significant higher than those of group B and C （P〈0. 05）, but no significant difference was observed between group B and C （P〉0. 05）. SPO2 was not significantly different between three groups （P〈0. 05）. VAS scores at 6, 12, 24 and 48 hours after operation in group B and C were significantly lower than those in group A （P〈0. 05）. Ramsay scores 6 and 12 hours after operation in group B and C were significantly higher than those in group A （P〈0. 05）. No respiratory depression was observed, no significant difference was observed in total incidences of nausea and vomiting, pruritus, urinary retention between three groups （P〉 0. 05）, incidence of dizziness in group C was significantly higher than those in group A and B （P〈0. 05）. CONCLUSION Dezocine 0. 020 mg·kg-1 · h-1 has good effects on sacral anesthesia under PPH operation after leading effects of patient-controlled intravenous analgesia, not increasing incidences of side effects.