地佐辛全麻诱导对脊柱外科患者术中唤醒试验的影响

Effects of general anesthesia induction with dezocine on intraoperative wake-up test in patients undergoing spinal surgery

目的:观察采用地佐辛的全麻诱导对行脊柱外科手术患者术中唤醒的影响。方法:56例ASAⅠ~Ⅱ级在静吸复合全麻下行脊柱内固定手术患者,随机分为D组(28例)和F组(28例)。F组以咪哒唑仑(0.04 mg/kg)、芬太尼(4μg/kg)、顺式苯磺酸阿曲库铵(0.2 mg/kg)、丙泊酚(1.5 mg/kg)常规诱导气管内插管;D组诱导前10 min缓慢静注地佐辛(0.2 mg/kg),但不使用芬太尼。两组患者麻醉维持方式相同。记录两组患者术中芬太尼的用量、唤醒期间失血量、唤醒成功所需的时间、氟马西尼的用量、需用肌松拮抗药的个体数,由外科手术医生评价唤醒试验的总体满意度,并比较两组患者停药即刻、唤醒实验成功即刻的动态有创血压、心率(HR)。结果:患者唤醒成功时间、氟马西尼用量对比无统计学意义,与F组比较,麻醉维持中D组芬太尼用量小(P<0.05),失血量少(P<0.05),需使用肌松拮抗个体数明显减少(P<0.01),唤醒成功时有创动脉收缩压、有创动脉舒张压明显降低,HR明显减慢(P<0.05),外科满意度优于F组(P<0.05)。结论:采用地佐辛的全麻诱导行脊柱外科手术时,不能缩短术中唤醒的时间,但可减少肌松拮抗药物的应用,减少唤醒期躁动,使血流动力学更稳定,外科满意度提高。

Objective： To observe the effect of dezocine during induction of general anesthesia on intraoperat ive wake-up test in patients undergoing spinal surgery. Methods ： A total of 56 ASA Ⅰ~Ⅱ patients that scheduled for intraoperative wake-up test in internal fixation of spine under general anesthesia were randomly divided in to group F（fentanyl） and D（dezocine）（n=28 each）. The general anesthesia induction of group F was adminis tered with midazolum（0.04 mg/kg）, fentanyl（4 μg/kg）, CIS atracurium（0.2 mg/kg）, propofol（1.5 mg/kg） and dezocine（0.2 mg/kg） were infused respectively 10 min before anesthesia induction without fentanyl in group D. The maintenance of general anesthesia in two groups were administered the same way. The dosage of fenta nyl, blood loss of wake-up period, anesthesia on arousing time, dosage of flumazenil, number of need muscle relaxant antagonist were monitored and recorded, The test overall satisfaction was evaluated by a surgeon, and the IBP、HR of drug stop time（T1） and test success time（T2） were compared. Results： The patients of the two groups had no insignificantly different in time needed to awaken and dosage of flumazenil. The group D got a lower dosage of fentanyl（P 〈0.05）, less blood loss（P 〈0.05）, lower ISBP、IDBP、HR in T2 compared with F, and the overall satisfaction were better（P〈 0.05）, the number of need muscle relaxant antagonist were reduced（P〈 0.01）. Conclusion： The induction of general anesthesia with dezocine in patients undergoing spinal surg ery, the time needed to awaken can＇t be reduced but the number of individuals need muscle relaxant antagonist, it can get a less evocation agitation and more stable hemodynamic, surgical satisfaction.