不同剂量地佐辛联合利多卡因用于宫腔镜检的麻醉效果:一项倾向配比研究

Clinical effect of different doses of dezocine combined with lidocaine in hysteroscopic surgery:a propensity score-matched comparison

目的:比较不同剂量地佐辛联合利多卡因用于门诊宫腔镜检查的临床效果。方法:回顾性分析2020年1月至12月在上海交通大学医学院附属第九人民医院辅助生殖科门诊接受宫腔镜检查的888例患者的临床资料,分为低剂量地佐辛组(L组)424例、高剂量地佐辛组(H组)464例,分别于术前5 min单次静脉注射地佐辛0.02、0.04 mg/kg,同时行2%利多卡因5 mL宫颈旁局部阻滞麻醉。根据患者临床特征进行倾向性配比,筛选出816例,每组408例。比较两组患者术中视觉模拟评分(VAS)、体动发生率、Ramsay镇静评分,术前术中心率(HR)、收缩压(SBP)、舒张压(DBP)、氧饱和度(SpO 2),以及术后恶心呕吐(PONV)等情况。结果:倾向性配比后,两组患者的年龄、体质量、手术时间、美国麻醉医师协会(ASA)分级,以及术前术中HR、SBP、DBP、SpO 2等差异均无统计学意义。H组患者术中VAS评分、体动发生率、Ramsay镇静评分均明显优于L组(P<0.01)。两组PONV发生率差异无统计学意义。结论:较大剂量地佐辛(0.04 mg/kg)静脉注射联合利多卡因局部麻醉对于接受门诊宫腔镜检查的患者具有较好的镇痛镇静作用,同时不良反应较小。

Objective:To compare the clinical effect of different doses of dezocine combined with lidocaine in hysteroscopy.Methods:The data of 888 patients undergoing hysteroscopy in the assisted reproduction outpatient in Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine from January to December in 2020,were retrospectively analyzed.The patients were divided into low-dose dezocine group(group L,n=424)and high-dose dezocine group(group H,n=464).Dezocine(0.02 mg/kg or 0.04 mg/kg)was intravenous injected 5 min before the operation,respectively.At the same time,5 mL of 2%lidocaine was injected for intraoperative local cervical block anesthesia.According to the clinical characteristics of patients,816 cases were selected by propensity score matching(PSM),with 408 cases in each group.Intraoperative visual analog score(VAS),body movement rate,Ramsay sedation score,preoperative and intraoperative heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),oxygen saturation(SpO 2),postoperative nausea and vomiting(PONV)were compared between the two groups.Results:After PSM,there were no significant differences in age,weight,operative time,ASA grade,preoperative and intraoperative HR,SBP,DBP,SpO 2 between the two groups.The intraoperative VAS score,body movement rate,and Ramsay sedation score in group H were significantly better than those in group L(P<0.01).There was no statistical difference in the incidence of PONV between the two groups.Conclusions:For patients undergoing outpatient hysteroscopy,higher dose of dezocine(0.04 mg/kg)intravenous injection combined with lidocaine local anesthesia has better analgesic and sedative effects,and has less adverse reaction.