地佐辛联合地塞米松预先给药对宫腔镜手术患者苏醒质量及术后镇痛效果的影响

Effect of pretreatment of Dezocine combined with dexamethasone on analgesia and recovery quality for hysteroscopy

目的观察地佐辛联合应用地塞米松预先给药对宫腔镜术后患者镇痛效果及苏醒质量的影响。方法择期行宫腔镜手术患者120例,ASAⅠ~Ⅱ级,年龄29~50岁,按随机数字表法随机分为3组,每组40例。3组患者均采用丙泊酚静脉麻醉,速度为3 mg/(kg·min)。A组术前15 min静脉注射地佐辛0.1mg/kg以及地塞米松10 mg;B组预先静脉注射地佐辛0.1 mg/kg;C组静脉注射生理盐水。记录患者入睡时间、手术时间、手术结束至睁眼时间、指令下握手时间、丙泊酚用药量以及呼吸抑制(Sp O2<93%或呼吸暂停>15 s)、恶心呕吐等胃肠道反应;评估患者术后宫缩痛和综合舒适满意度。结果 3组患者入睡时间、手术时间差异无统计学意义(P>0.05)。B组丙泊酚用量显著少于C组(P<0.05),呼吸抑制发生率显著低于C组(P<0.05),B组术后睁眼时间和定向力恢复时间明显短于C组(P<0.05),B组术后2、4 h的VAS评分低于C组(P<0.05)。术后8 h、12 h、24 h A组患者VAS评分明显低于B组,组间比较差异有统计学意(P<0.05)。A组恶心的发生率明显低于B组(P<0.05)。结论宫腔镜手术患者术前联合应用地佐辛与地塞米松可有效预防术后疼痛,缩短苏醒时间及定向力恢复时间,减少不良反应,提高综合满意度,加速术后康复。

Objective To investigate the analgesic and sedative effects of pretreatment of dezocine in combination with dexamethasone in patients with hysteroscopy. Methods A total of 120 patients with selective hysteroscopy （ ASA I - II, aged 29 -50 years） were randomly assigned to 3 groups. All patients were given with intravenous propofol by 3 mg/kg ~ rain in the induction of anesthesia. Group A additionally received an intravenous injection of dezoeine （0. 1 mg/kg） and dexamethasone （10 mg） 15 rain before operation. Group B was further given with dezocinc （0. 1 mg/kg）. Group C re- ceived intravenous saline as placebo. The time for falling asleep, the operation time, the recovery time （from the end of surgery to opening eyes upon callings） , the time of shaking hands under instructions, the total amounts of propofol and re- spiratory inhibition （SpO2 〈 93% or apnea 〉 15 s）, and postoperative adverse reaction （e. g. nausea and vomiting） were recorded. Postoperative uterine contraction pain and visual simulation score （VAS） were also evaluated. Results There was no significant difference in the time for falling asleep or the operation time among the three groups （ P 〈 0. 05 ）. The dosage of propofol and the incidence of respiratory inhibition were significantly lower in Group B than Group C （P 〈 0. 05 ）. The recovery time and directional force recovery were significantly shorter in Group B than Group C （ P 〈 0.05 ）. The VAS scores 2 and 4 hours after operation in Group B were significantly less than Group C （ P 〈 0. 05 ）. The VAS scores 8, 12 and 24 hours after operation and the incidences of nausea and vomiting in Group A were significantly lower than Group B （ P 〈 0. 05 ）. Conclusion The combined application of dezocine and dexamethasone before hysteroscopic surgery can effectively relieve postoperative pain, shorten recovery time, reduce adverse reactions, and improve compre- hensive satisfaction.