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 resuscitation of patients with quality of dezocine anesthesia

目的：分析不同剂量纳洛酮对地佐辛麻醉后患者复苏质量的影响。方法选择行地佐辛麻醉手术的患者84例，按照使用纳洛酮剂量不同分为三组，每组28例。所有患者均给予静脉注射丙泊酚、芬太尼及顺式阿曲库铵进行麻醉诱导，后行气管插管机械通气，术中给予地佐辛输注维持麻醉。术后高剂量组给予14μg／kg 纳洛酮，低剂量组给予7μg／kg 纳洛酮，对照组仅给予对应剂量的0．9％氯化钠注射液进行静脉滴注。观察三组患者麻醉前、苏醒时、拔管时平均动脉压（MAP）、心率（HR），采用视觉疼痛模拟评分（VAS）、镇静／躁动评分（SAS）对患者苏醒后1 min、1 h、2 h 疼痛及镇静情况进行评分。同时记录三组患者术并发症及不良反应发生情况。结果三组患者麻醉前的 MAP 及 HR 指标比较差异均无统计学意义，低剂量组苏醒时、拔管时的 MAP、HR 与对照组比较差异无统计学意义（均 P ＞0．05）。但在麻醉苏醒时、拔管时，低剂量组患者的 MAP、HR 均显著低于高剂量组。低剂量组患者苏醒各时刻 VAS、SAS 评分与对照组差异无统计学意义，但高剂量组患者苏醒各时刻 VAS、SAS 评分均显著高于对照组和低剂量组，差异有统计学意义。高剂量组和低剂量组发生呼吸抑制的情况显著低于对照组（0、3．57％、10．71％，χ^2＝4．169、1．077，均 P ＜0．05），但高剂量组患者发生恶心、呕吐的情况高于对照组和低剂量组，差异有统计学意义（均 P ＜0．05）。结论针对使用地佐辛麻醉手术的患者，在术后可根据患者的情况不同使用不同剂量的纳洛酮，以降低呼吸抑制，同时帮助患者缓解疼痛和躁动的情况，推荐使用7μg／kg 的剂量。

Objective To analyze the effects of different doses of naloxone on resuscitation of patients with quality of dezocine anesthesia.Methods 84 patients with dezocine anesthesia surgery were selected and divided into three groups in accordance with the use of naloxone plus volume,28 cases in each group.All patients were treated with vein injection of propofol,fentanyl and Shun type atracurium for induction of anesthesia,endotracheal intubation and mechanical ventilation were given dezocine infusion to maintain anesthesia.After the operation,the high dose group was given 14μg/kg naloxone,the low dose group was given 7μg/kg naloxone,and the control group only received intravenous infusion of the corresponding measurement.Mean arterial pressure （map）,heart rate （HR）before anes-thesia,recovery,extubation and intubation after 10min of three groups were observed.Pain and sedation situation score of the patients regained consciousness after 1min,1h,2h were received by visual analogue scale （VAS）,sedation/restlessness score （SAS）.At the same time,the incidence of complications and adverse reactions of the three groups were recorded.Results There were no significant differences in MAP and HR indexes among the three groups before anesthesia.At resuscitation and extubation there were no differences in MAP and HR between the low dose group and the control group （all P 〉0.05）.However,resuscitation,extubation,MAP and HR were significantly lower in the low dose group than those in the high dose group （all P 〈0.05）.The difference of VAS,SAS score had no statistical sig-nificance between the low dose group waken up each time and control group,but the VAS,SAS score in the high dose group waken up each time were significantly higher than those in the control group and low dose group（all P 〈0.05）. The respiratory inhibition in the high dose group and low dose group were significantly lower than those of the control group（0,3.57% and 10.71%;χ2 =4.169,1.077,all P 〈0.05）,but nausea and vomiting in the high dose group were higher than those in the control group and low dose group（all P 〈0.05）.Conclusion Different doses of nalox-one could be used for patients using dezocine anesthesia according to patients after operation,to reduce respiratory inhibi-tion,and help patients relieve pain and agitation,and the recommend dose of naloxone is 7μg/kg.