地佐辛对行结肠镜检患者的镇痛及镇静效果分析

Analysis of the analgesic and sedative effects of dezocine for patients undergoing colonoscopy

目的:探讨地佐辛对行结肠镜检患者的镇痛及镇静效果分析。方法:选取大连大学附属新华医院院2016年3―5月的106例行结肠镜检的患者,随机分为肌注地佐辛组和静注地佐辛组各53例,分别于结肠镜检前30 min进行地佐辛0.2 mg·kg^(-1)肌肉注射或静脉注射。选取53例采用芬太尼进行结肠镜检镇痛的患者作为对照组,结肠镜检前15 min肌肉注射1μg·kg^(-1)芬太尼,采用焦虑自评量表(SAS)评分评价患者的焦虑情况,采用视觉模拟评分(visual analogue scale,VAS)评分评价患者的疼痛情况,观察3组患者结束镜检后及苏醒时、苏醒后1 h、2 h的SAS评分、VAS评分及恶心呕吐、呼吸抑制等不良反应。结果:苏醒时对照组的VAS评分明显低于肌注地佐辛组,差异有统计学意义(P<0.05);但与静注地佐辛组无统计学意义(P>0.05);肌注地佐辛组和静注地佐辛组之间差异无统计学意义(P>0.05);苏醒后1 h,对照组的VAS评分高于肌注地佐辛组和静注地佐辛组,但无统计学意义(P>0.05);静注地佐辛组VAS评分高于肌注地佐辛组,具有统计学意义(P<0.05);苏醒后2 h,对照组的VAS评分高于静注地佐辛组和肌注地佐辛组,差异有统计学意义(P<0.05);静注地佐辛组VAS评分明显高于肌注地佐辛组,差异有统计学意义(P<0.05);苏醒时,对照组的SAS评分明显高于肌注地佐辛组和静注地佐辛组,差异有统计学意义(P<0.05);肌注地佐辛组的SAS评分明显低于静注地佐辛组,差异有统计学意义(P<0.05);苏醒后1 h,对照组的SAS评分明显高于肌注地佐辛组和静注地佐辛组,差异有统计学意义(P<0.05);静注地佐辛组SAS评分明显高于肌注地佐辛组,差异有统计学意义(P<0.05);苏醒后2 h,对照组和静注地佐辛组的SAS评分明显高于肌注地佐辛组,差异有统计学意义(P<0.05),而且肌注地佐辛组的SAS评分明显低于静注地佐辛组,差异有统计学意义(P<0.05)。肌注地佐辛组发生不良反应发生率(0.0%)明显低于对照组(18.9%)和静注地佐辛组(35.8%),差异有统计学意义(P<0.05)。结论:在结肠镜检前30 min进行肌注地佐辛,可以有效的提高结肠镜检后镇痛、镇静效果,安全性好。

Objective： To study the analgesic and sedative effects of dezocine in patients undergoing colonoscopy. Methods： A total of 106 patients undergoing colonoscopy and using dezocine from March to May 2016 were selected and randomly divided into intramuscular administration group and intravenous administration group （n=53）. Dezocine was given at the dosage of 0.2 mg·kg-1 at 30 min before colonoscopy. Fifty-three cases using fentanyl for colonoscopy analgesia were selected as the control group and intramuscularly injected fentanyl at the dosage of 1 μg·kg-1 at 15 min before colonoscopy. Patients＇ anxiety was evaluated using Self-rating Anxiety Scale （SAS）, and patients ＇ pain was evaluated using Visual Analogue Scale （VAS）. SAS score, VAS score, nausea and vomiting, respiratory depression, and adverse reactions at the time of recovery and 1 h and 2 h after recovery were recorded. Results： At the time of recovery, the VAS score of the control group was significantly lower than that in the two dezocine groups （P〈0.05）. At 1 h after recovery, the VAS score of the control group was higher than that in the two dezocine groups, but without statistical significance （P〉0.05）. The incidence of adverse reactions （0.0%） in dezocine intramuscular administration group was significantly lower than those of the control group （18.9%）and the dezocine intravenous administration group （35.8%） （P〈0.05）. Conclusion： Intramuscular injection of dezocine at 30 rain before colonoscopy can effectively improve the analgesic and sedative effects and safety.