地佐辛对高血压患者术后导管相关膀胱刺激症(CRBD)的临床研究

Effect of dezocine on postoperative catheter-related bladder discomfort(CRBD) in patients with hypertension after general anesthesia

目的观察地佐辛对高血压患者术后导管相关膀胱刺激症(CRBD)的影响。方法选取我院接受全麻下腹腔胆囊镜手术的男性高血压患者80例,随机分为2组,每组40例。A组在手术结束前30 min静脉注射地佐辛,B组则注射等量生理盐水,设定术毕即刻,术后1、2、6 h为T_0、T_1、T_2、T_3,观察4个时间点两组患者心率(HR)、平均动脉压(MAP)、心肌耗氧指数(RPP)、视觉疼痛模拟评分(VAS)、镇静评分(Ramsay)以及血浆肾上腺素(E)、去甲肾上腺素(NE)浓度;记录两组术后苏醒时间、呼吸恢复时间以及术后6 h芬太尼静脉自控镇痛(PCIA)用量;观察两组术后24 h CRBD及不良反应的发生情况。结果B组HR、MAP、RPP、E、NE及VAS、Ramsay在T_0~T_3时刻变化显著,差异有统计学意义(P<0.05);T_0、T_3时,两组HR、MAP、RPP及E、NE比较,差异无统计学意义(P>0.05),但T_1、T_2时,A组显著低于B组;T_2时,A组VAS评分显著低于B组,Ramsay评分高于B组,差异有统计学意义(P<0.05);A组术后芬太尼PCIA用量、CRBD发生率、呼吸抑制、呛咳、皮肤瘙痒、恶心呕吐等不良反应发生例数明显少于B组,差异有统计学意义(P<0.05)。结论术毕前30 min静脉使用地佐辛能预防高血压患者术后CRBD发生,且不影响循环系统,安全有效。

Objective To observe the effect of dezocine （DEZ） on postoperative catheter-related bladder discomfort （CRBD） in patients with hypertension after general anesthesia. Methods Totally 80 cases of male patients with hypertension who received general anesthesia in our hospital were randomly divided into group A and group B ,40 cases in each group. Group A was given DEZ at 30 rain prior to the end of surgery, while group B received the same amount of NS. The time points of immediately 0 h,1 h,2 h and 6 h after the surgery were set as T0 ,T1 ,T2 and T3. The HR, MAP, RPP, VAS, Ramsay, concentration of the E and NE in plasma of the two groups were observed. The time of respiratory recovery and the resuscitation, the dose of the PICA on fentanyl, the occurrence number of the CBRD and reactions were recorded. Results MAP, RPP, E, NE, VAS and Ramsay were significantly different at To - T3 time points, and the difference was statistically significant （ P 〈 0. 05 ） ; the difference of HR, MAP, RPP and E, NE was not statistically significant at TO and T3 （ P 〉 0. 05 ） , but at T1 and T2 , the indexes in group A were significantly lower than those of group B ; the VAS score of group A was significantly lower than that of group B and the Ramsay score was higher at T2 time point （P 〈 0. 05 ）. There were significant differences in the dose of fentanyl of the PICA, occurrence number of the CBRD, respiratory depression, bucking, itchy skin, nausea and vomiting between group A and group B （ P 〈 0. 05 ）. Conclusion Intravenous dezocine 30 min before surgery can prevent CRBD in patients with hypertension after operation, and does not affect the circulatory system, which is safe and effective.