不同剂量地佐辛超前镇痛对老年患者全麻苏醒期应激反应的影响

Preemptive analgesic effect of different doses of dezocine on stress response in recovery period of general anesthesia in elderly patients

目的观察不同剂量地佐辛预防老年患者在全麻苏醒期应激反应的临床效果。方法择期行腹腔镜胆囊切除术的老年患者60例,随机分为地佐辛1组（D_1组）、地佐辛2组（D_2组）、舒芬太尼组（S组）、对照组（C组）。D_1组术前30 min静注地佐辛0.1 mg/kg,D_2组术前30 min静注地佐辛0.2 mg/kg,S组术前30 min静注舒芬太尼0.2μg/kg,C组术前30 min静注生理盐水2 m L。检测用药前（T_0）、手术结束时（T_1）、拔除气管导管即刻（T_2）、拔除气管导管后10 min（T_3）时的血浆皮质醇、血糖、MAP、HR、Sp O_2。记录2组苏醒时间、拔管时间及不良反应发生情况,比较拔管后10 min（T_3）时评估患者的Ramsay镇静评分、VAS评分。结果与T_0比较,D_1组和C组T_2、T_3时MAP和HR均显著升高（P〈0.05）,且C组显著高于其他3组（P〈0.01）,D_1组又显著高于D_2组和S组（P〈0.05）。与C组比较,D_1、D_2、S组T_1~T_3时的血浆皮质醇和血糖浓度显著降低,且D_2组显著低于D_1组和S组（P〈0.05）。D_1组和D_2组的Ramsay镇静评分显著高于S组和C组（P〈0.05）。D_1、D_2、S组拔管后VAS评分显著低于C组（P〈0.05）。D_1、D_2、C组苏醒时间和拔管时间显著短于S组,S组有3例患者出现一过性Sp O_2〈90%（P〈0.05）。结论术前静脉注射0.2 mg/kg地佐辛可有效降低老年患者全麻苏醒期应激反应,不良反应少。

Objective To investigate effect of different doses of dezocine on prevention of stress response in recovery period of general anesthesia in elderly patients. Methods Sixty elderly patients with selective laparoscopic cholecystectomy（ LC） under general anesthesia were randomly divided into dezocine 1 group（ group D_1）,dezocine 2 group（ group D_2）,sufentanil group（ group S）and control group（ group C）. Group D_1 was treated with 0. 1 mg / kg dezocine intravenously 30 minutes before operation,group D_2 was treated with 0. 2 mg / kg dezocine intravenously 30 minutes before operation,group S was treated with 0. 2 μg / kg sufentanil intravenously 30 minutes before operation,and group C was treated with 2 m L saline intravenously 30 minutes before operation. Plasma glucose（ Glu）,cortisol（ Cor）,MAP and HR before drug administration（ T_0）,at the end of surgery（ T_1）,immediately after extubation（ T_2） and 10 minutes after extubation（ T_3） were detected. Consciousness recovery time,extubation time and adverse events were recorded. Ramsay sedation score and VAS score at T_3 were compared between two groups. Results MAP and HR at T_2,T_3 in group D_1 and group C increased significantly when compared with those at T_0（ P〈0. 05）,MAP and HR in group C were significantly higher than those in the other three groups（ P〈0. 01）,and MAP and HR in group D_1 were significantly higher than group D_2 and group S（ P〈0. 05）. Compared with group C,Glu and Cor at T_1 to T_3in group D_1,group D_2 and group S decreased significantly,and Glu and Cor in group D_2 were significantly lower than group D_1 and group S（ P〈0. 05）. Ramsay score in group D_1 and group D_2 was significantly higher than that in group S and group C（ P〈0. 05）. VAS score in group D_1,group D_2 and group S decreased significantly（ P〈0. 0 5）. The consciousness recovery time and extubation time in group C were significantly longer than those in other groups（ P〈0. 05）. In group S,three patients had transient Sp O_2 below 90%（ P〈0. 05）. Conclusion Preoperative intravenous injection of 0. 2 mg / kg dezocine can effectively reduce the stress response in recovery period of general anesthesia in elderly patients,and adverse reactions are less.