不同剂量地佐辛对围拔管期患者的影响

Effect on different doses of Decozine during anesthesia recovery

目的比较不同剂量地佐辛对围拔管期患者的影响。方法所有患者均常规全麻,在手术结束前30min,A组、B组、C组和D组静脉分别缓慢注射地佐辛0.1mg/kg、地佐辛0.2mg/kg、舒芬太尼1μg/kg、生理盐水3ml。术毕待患者自然苏醒后拔出气管导管。分别记录患者自主呼吸恢复时间、苏醒时间、拔管时间,以及不良反应的发生率。记录手术前(基础值T_0)及拔管时(T_1),拔管后1min(T_2)、5min(T_3)、10min(T_4)的MAP、HR、SPO2和Ramsay镇静评分。记录患者拔管后15min、30min、1h、2h、4h的VRS疼痛评分。结果与D组比较,B组自主呼吸恢复时间、苏醒时间和拔管时间明显延迟,差异有统计学意义(P<0.05)。与A、B、C组比较,D组在T_1时HR明显增快(P<0.05);与A组比较,D组在T_2时HR明显增快(P<0.05)。与A组比较,B组在拔管后30min、1h、2h的VRS疼痛评分明显降低(P<0.05);与C组比较,B组在拔管后1h、2h的VRS疼痛评分明显降低(P<0.05)。与A、C、D组比较,B组在呼吸抑制、恶心、呕吐、嗜睡等方面不良反应的发生率明显升高(P<0.05);与A、C组比较,D组在呛咳、躁动、咽喉痛、头痛、头晕和高血压等方面不良反应的发生率明显升高(P<0.05)。结论 0.1mg/kg地佐辛有明显的术后镇痛、镇静作用,能有效降低拔管时的不良反应,对血流动力学影响更加平稳。同时地佐辛不延长苏醒和拔管的时间,减轻了苏醒期的躁动,提高了患者的苏醒质量,更加适合临床应用。

Objective To compare the effect on different doses of decozine during anesthesia recovery. Methods Under general anesthesia,the patients slowly received 0.1mg/kg of intravenous decozine(group A),0.2mg/kg of intravenous decozine(group B),1μg/kg of intravenous sufentanil(group C),or 3ml of normal saline(group D) respectively at30 min before the end of surgery. Pulled out the endotracheal tube when patients waked after operation. The postoperative spontaneous breathing recovery time,awakening time,the extubation time and incidence of side effects were recorded. Recorded the MAP,HR,SPO2 and Ramsay score before operation,and 1min,5min,10 min after extubation. VRS pain scores of all patients was recorded at 15 min,30min,1h,2h and 4h after extubation. Results Compared with group D,spontaneous breathing recovery,awakening time and extubation time of group B were significantly prolonged(P<0.05). Compared with group A,group B,group C,HR at T1 in the group D elevated obviously(P<0.05). HR at T2 was significantly faster in group D than group A(P<0.05). 30 min,1h and 2h after extubation,VRS pain scores was significantly lower in group B than group A(P<0.05).1h and 2h after extubation,VRS pain scores significantly lower in group B than group C(P<0.05). The side effect of all patients,group B was higher than other groups. Compared with group A and group C,the incidence of irritative cough,dysphoria,pharyngalgia,dizziness headache and hypertension during tracheal extubation in group D was significantly increased(P<0.05). Concusion 0.1mg/kg of intravenous decozine can effectively improve the analgesia,decrease adverse reactions,steady the influence for hemodynamics,decrease dysphoria during awaking period,increase the recovery quality,also it doesn't extend awaking and tube drawing time. It's suited to the clinical application.