地佐辛预防性镇痛在妇科腹腔镜手术中的应用效果

Effect of dezocine on preemptive analgesia in patients undergoing laparoscopic gynecological surgery

目的探讨地佐辛预防性镇痛在妇科腹腔镜手术中的应用效果。方法选择择期行妇科腹腔镜手术的患者60例,随机分入地佐辛组和对照组,每组30例。所有患者均选用气管插管全身麻醉,地佐辛组于麻醉诱导前5min静脉缓慢注射地佐辛0.1mg/kg(用0.9%氯化钠溶液稀释至5mL),对照组注射等量0.9%氯化钠溶液。采用Riker镇静和躁动评分(SAS评分)评估患者围拔管期的躁动程度,采用疼痛视觉模拟评分(VAS评分)评估患者术后5min、30min、1h、2h、4h和6h的疼痛程度,观察患者术后不良反应的发生情况和盐酸哌替啶的使用情况。结果两组间围拔管期SAS评分和术后5、30min的疼痛VAS评分的差异均无统计学意义(P值均>0.05),地佐辛组术后1、2、4、6h的疼痛VAS评分均显著低于对照组同时间点(P值均<0.05)。两组间术后恶心呕吐、嗜睡、头晕、呼吸抑制和皮肤瘙痒发生率的差异均无统计学意义(P值均>0.05),但地佐辛组术后使用盐酸哌替啶的患者比例显著低于对照组(P<0.05),对照组使用盐酸哌替啶的时间约在术后6h。结论妇科腹腔镜手术麻醉诱导前5min使用地佐辛,可以有效减轻患者的术后疼痛,减少术后镇痛药物的使用,且无明显不良反应。

Objective To explore the effect of dezocine on preemptive analgesia in patients undergoing laparoscopic gynecological surgery. Methods Sixty patients scheduled for laparoscopic gynecological surgery were randomly divided into dezocine group and control group （ n = 30 each）. All patients in both groups received general anesthesia. Five minutes before anesthesia induction, dezocine （0.1 mg/kg, diluted with normal saline to 5 mL） and normal saline （the same volume） were intravenously given in the dezocine group and control group, respectively. The degree of agitation was evaluated by sedation agtation scale （SAS） before and after extubation. The degree of pain was assessed by visual analgue scale （VAS） 5 min, 30 min, 1 h, 2 h, 4 h, and 6 h postoperatively. Adverse reaction and use of pethidine were recorded. Results There were no significant differences in SAS scores during extubation period, VAS score at 5 min or 30 min after surgery between groups （all P〉0. 05）, but the VAS score at 1 h, 2 h, 4 h, and 6 h after operation in the dezocine group were significantly lower than those of the control group （all P〈0.05）. There were no significant differences in the incidence of nausea, vomitting, drowsiness, dizziness, respiratory depression, or skin itch between groups （all P〉0.05）. The amount of patients in need of pethidine in the dezocine group was significantly less than control group （ P〈 0.05）, and the pethidine was given about 6 h postoperatively in the control group. Conclusion The use of dezocine at 5 min before anesthesia induction in laparoscopic gynecological surgery can effectively relieve postoperative pain, reduce postoperative analgesic use, and has no obvious adverse reactions. （Shanghai Med J, 2016, 39： 85-88）