腹腔镜下子宫肌瘤切除术后地佐辛自控镇痛剂量选择和效果分析

Dose selection of dizosin self-controlled analgesia after laparoscopic myomectomy and its effect analysis

目的分析腹腔镜下子宫肌瘤切除术后地佐辛自控镇痛剂量选择和效果。方法84例行腹腔镜下子宫肌瘤切除术的子宫肌瘤患者,随机分为多量组和少量组,各42例。两组患者均给予地佐辛自控镇痛,多量组采用1.0 mg/kg地佐辛+3 mg/kg盐酸氯胺酮注射液+8 mg盐酸昂丹司琼注射液;少量组采用0.6 mg/kg地佐辛+3 mg/kg盐酸氯胺酮注射液+8 mg盐酸昂丹司琼注射液,镇痛时间为24 h。所有患者均采取LCP模式给药。比较两组患者地佐辛及氯胺酮用量;两组患者术后2、4、8、12及24 h视觉模拟评分法(VAS)评分及Ramsay镇静评分;两组患者不良反应发生情况及肛门恢复排气时间。结果多量组地佐辛用量为(48.42±3.65)mg,多于少量组的(33.41±3.94)mg,差异有统计学意义(P<0.05)。两组氯胺酮用量比较,差异无统计学意义(P>0.05)。两组患者术后2、4、8、12及24 h VAS评分比较,差异无统计学意义(P>0.05)。少量组术后2、4、8、12及24 h Ramsay镇静评分分别为(2.27±0.43)、(2.11±0.30)、(2.68±0.46)、(2.81±0.65)、(2.28±0.50)分,均低于多量组的(3.12±0.72)、(3.41±0.63)、(3.02±0.58)、(3.18±0.41)、(2.49±0.42)分,差异均有统计学意义(P<0.05)。两组患者术后恶心呕吐、头晕头痛及心动过速发生率比较,差异均无统计学意义(P>0.05)。少量组肛门恢复排气时间为(23.3±2.7)h,短于多量组的(28.7±4.3)h,差异有统计学意义(P<0.05)。结论地佐辛用于腹腔镜下子宫肌瘤切除术后自控镇痛效果良好,患者综合满意度高,用药剂量推荐0.6 mg/kg。

Objective To analyze the dose selection of dizosin self-controlled analgesia after laparoscopic myomectomy and its effect.Methods A total of 84 cases of laparoscopic myomectomy were randomly divided into high-dose group and low-dose group,with 42 cases in each group.Both groups received dizosin self-controlled analgesia,and high-dose group received 1.0 mg/kg dizosin+3 mg/kg ketamine hydrochloride injection+8 mg ondansetron hydrochloride injection.Low-dose group received 0.6 mg/kg dizosin+3 mg/kg ketamine hydrochloride injection+8 mg ondansetron hydrochloride injection.The analgesic time was 24 h.Comparison was made on dose of dizosin and ketamine,visual analogue scale(VAS)score and Ramsay sedation score at 2,4,8,12 and 24 h after operation,occurrence of adverse reactions and recovery time for anal exsufflation between the two groups.Results The dose of dizosin was(48.42±3.65)mg in high-dose group,which was more than(33.41±3.94)mg in low-dose group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in dose of ketamine between the two groups(P>0.05).There was no statistically significant difference in VAS score at 2,4,8,12 and 24 h after operation between the two groups(P>0.05).The Ramsay sedation score at 2,4,8,12 and 24 h after operation were(2.27±0.43),(2.11±0.30),(2.68±0.46),(2.81±0.65)and(2.28±0.50)points in low-dose group,which was lower than(3.12±0.72),(3.41±0.63),(3.02±0.58),(3.18±0.41)and(2.49±0.42)points in high-dose group.Their difference was statistically significant(P<0.05).There was no statistically significant difference in incidence of postoperative nausea,vomiting,dizziness,headache and tachycardia between the two groups(P>0.05).The recovery time for anal exsufflation was(23.3±2.7)h in low-dose group,which was shorter than(28.7±4.3)h in high-dose group,and the difference was statistically significant(P<0.05).Conclusion Dizosin has a good effect on patient-controlled analgesia after laparoscopic hysteromyomectomy,and the patient's comprehensive satisfaction is high.The recommended dosage is 0.6 mg/kg.