不同剂量纳洛酮对地佐辛麻醉后患者复苏质量的影响

Effects of different doses of naloxone on postanesthesia resuscitation quality in patients anesthetized with dezocine

目的探讨纳洛酮对地佐辛麻醉后复苏期间患者呼吸抑制及苏醒延迟的拮抗作用。方法择期行胃肠手术的患者150例,ASAⅠ-Ⅱ级,年龄35-65岁,体重50-70 kg,随机分成3组：低剂量组、高剂量组和空白对照组。静脉注射丙泊酚、芬太尼和顺式阿曲库铵麻醉诱导,气管插管后机械通气,术中恒速输注地佐辛1-3μg/（kg·min）维持镇痛,术毕送PACU。低剂量组和高剂量组分别给予7、14μg/kg纳洛酮各溶于100 m L生理盐水静脉滴注10 min,空白对照组单纯给予100 m L生理盐水静脉滴注10 min。记录麻醉前、苏醒时、拔管时及拔管后10 min患者平均动脉压（MAP）与心率（HR）;进行苏醒后即刻、1 h、2 h时视觉模拟评分（VAS）、布氏舒适评分（BCS）和镇静/躁动评分（SAS）;记录患者苏醒时间、拔除气管导管时间及离开PACU时间;观察术后48 h内呼吸抑制、恶心呕吐、心律失常等并发症的发生情况。结果 3组患者麻醉前MAP、HR基础值差异无统计学意义（P〉0.05）;与空白对照组比较,高剂量组患者在苏醒时、拔管时及拔管后10 min的MAP、HR均明显升高（P〈0.05）;而低剂量组各时点MAP、HR与空白对照组差异无统计学意义（P〉0.05）;在苏醒、拔管及拔管后10 min时低剂量组MAP、HR明显低于高剂量组（P〈0.05）。与空白对照组比较,低剂量组、高剂量两组患者的苏醒、拔除气管导管及离开PACU时间均明显缩短（P〈0.05）;低剂量组与高剂量组苏醒、拔除气管导管及离开PACU时间差异无统计学意义（P〉0.05）。与空白对照组比较,低剂量组患者苏醒即刻、1 h、2 h时VAS、BCS评分差异无统计学意义（P〉0.05）,苏醒即刻及1 h时SAS评分升高（P〈0.05）;高剂量组患者苏醒即刻、1 h、2 h时VAS评分升高,BCS评分降低,SAS评分升高（P〈0.05）;高剂量组患者苏醒即刻、1 h、2 h时VAS评分较低剂量组升高,BCS评分降低,SAS评分在苏醒即刻及1 h时升高（P〈0.05）。空白对照组有5例（10%）发生苏醒期呼吸抑制,低剂量组有1例（2%）,高剂量组无人发生,低剂量组、高剂量组呼吸抑制发生率低于空白对照组（P〈0.05）,高剂量组低于低剂量组;高剂量组有1例（2%）患者发生恶心呕吐;3组均无人发生心律失常。结论地佐辛麻醉术后复苏期纳洛酮能够显著缩短患者苏醒时间,降低呼吸抑制的发生率,同时不增加患者疼痛及躁动,纳洛酮的推荐剂量以7μg/kg为好。

Objective To investigate the effect of different doses of naloxone on respiratory depression and delayed recovery of postanesthesia patients anesthetized with dezocine. Methods 150 patients,aged 35- 65 years old,with an ASA score of Ⅰ- Ⅱ,weighed 50- 70 kg,scheduled for gastrointestinal surgery,were randomly allocated into 3groups,namely,low dose naloxone（ L）,high dose naloxone（ H） and control（ C）. All patients were given propofol,fentanil and cis- atracurium for induction. After intubation,dezocine 1- 3 μg /（ kg·min） were continued using intravenous pump during surgery. All patients were monitored in PACU after surgery. Group L and H were given intravenous naloxone7 and 14 μg / kg,respectively,in 100 m L of saline,while group C were given 100 m L of saline only. Mean arterial pressure（ MAP） and heart rate（ HR） were recorded before anesthesia,during resuscitation,during extubation and 10 min after extubation. Visual analogue scale（ VAS）,Bruggemann comfort scale（ BCS） and Sedation- Agitation Scale（ SAS） were measured immediately,1 h and 2 h after resuscitation. Time of recovery,extubation and leaving PACU were also recorded. And the incidence rate of respiratory depression,vomiting and nausea,and arrhythmia were measured. Results There was no statistically significant difference among three groups in MAP and HR before anesthesia（ P〉0. 05）. However,patients in Group H presented elevated MAP and HR during resuscitation,extubation and 10 min after extubation compared to Group C（ P〈0. 05）,while MAP and HR in Group L were lower than Group H at these time points（ P〈0. 05）and not different fro Group C（ P〉0. 05）. Compared to group C,time of resuscitation,extubation and leaving PACU were shorter in Group L and Group H（ P〈0. 05）,and there was no difference between group L and H（ P〉0. 05）. Compared to group C,VAS and BCS scores of patients in Group L were not different immediately,1 h and 2 h after resuscitation（ P〉0. 05）,but SAS score was higher in Group L immediately and 1 h after resuscitation（ P〈0. 05）. While in group H,VAS scores increased,BCS scores decreased,SAS scores increased immediately and 1,2 h after resuscitation（ P〈0. 05）. There were 5 patients（ 10%） in Group C,1 patient（ 2%） in Group L in whom respiratory depression occurred（ P〈0. 05）. 1 patient（ 2%） in Group H had vomiting,and there was no arrhythmia in any of the 3 groups. Conclusion Using naloxone at 7 μg / kg during postanesthesia period reduces resuscitation time efficiently,decreases the incidence of respiratory depression,without increasing pain and agitation in patients who had been anesthetized with dezocine during surgery.