地佐辛静脉麻醉在腹腔镜下胃癌手术患者中的应用效果及安全性

Application effect and safety of dezocine intravenous anesthesia in patients undergoing laparoscopic gastric cancer surgery

目的探讨地佐辛静脉麻醉在腹腔镜下胃癌手术患者中的应用效果及安全性。方法根据手术麻醉用药方案的不同将116例腹腔镜下胃癌手术患者分为常规组和观察组,每组58例,常规组患者采用常规麻醉,观察组患者在常规麻醉的基础上于手术结束前30 min静脉注射地佐辛。比较麻醉诱导前5 min(T_(0))、术毕(T_(1))、拔管即刻(T_(2))、拔管后10 min(T_(3))、拔管后30 min(T_(4))两组患者的生命体征指标(心率、收缩压、舒张压),比较术后即刻及术后12、24、48 h两组患者的疼痛程度[视觉模拟评分法(VAS)]、认知功能[简易精神状态量表(MMSE)],比较术前1天、术后1天两组患者的应激反应指标[血清皮质醇(Cor)、丙二醛(MDA)、肾上腺素(E)、去甲肾上腺素(NE)],比较两组患者的苏醒质量(Ricker镇静-躁动评分、睁眼时间、拔管时间)、术后镇痛药物用量及不良反应发生率。结果T_(3)时刻,观察组患者的心率明显低于常规组(P﹤0.01);T_(2)、T_(3)时刻,观察组患者的收缩压、舒张压均低于常规组(P﹤0.05)。术后即刻及术后12、24、48 h,观察组患者的VAS评分均低于常规组,术后即刻及术后12、24 h,观察组患者的MMSE评分均高于常规组,差异均有统计学意义(P﹤0.05)。术后,两组患者的Cor、MDA、E、NE水平均高于本组术前,观察组患者的Cor、MDA、E、NE水平均低于常规组,差异均有统计学意义(P﹤0.05)。两组患者睁眼时间、拔管时间比较,差异均无统计学意义(P﹥0.05);观察组患者Ricker镇静-躁动评分明显低于常规组,术后舒芬太尼用量明显少于常规组,差异均有统计学意义(P﹤0.01)。两组患者的不良反应总发生率比较,差异无统计学意义(P﹥0.05)。结论地佐辛静脉麻醉能够维持腹腔镜下胃癌手术患者术中生命体征平稳,有效减轻患者术后苏醒期躁动,缓解术后疼痛,从而减轻术后应激反应,且用药安全。

Objective To investigate the application effect and safety of dezocine intravenous anesthesia in patients undergoing laparoscopic gastric cancer surgery.Method A total of 116 patients who underwent laparoscopic gastric cancer surgery were divided into routine group and observation group according to different surgical anesthesia regimens,with 58 cases in each group.The patients in the routine group were given routine anesthesia,while the patients in the observation group were given intravenous injection of dezocine 30 minutes before the end of the surgery based on the routine regimen.The vital signs(heart rate,systolic blood pressure,diastolic blood pressure)were compared between the two groups at 5 minutes before anesthesia induction(T_(0)),after the surgery(T_(1)),immediately after extubation(T_(2)),10 minutes after extubation(T_(3)),and 30 minutes after extubation(T_(4)).The pain level[visual analogue scale(VAS)]and cognitive function[mini-mental state examination(MMSE)]were compared between the two groups immediately,12 h,24 h,and 48 h after surgery.The stress response indexes[serum cortisol(Cor),malondialdehyde(MDA),epinephrine(E),and norepinephrine(NE)]in the two groups were compared 1 day before surgery and 1 day after surgery.The quality of recovery(Ricker Sedation-Agitation score,time to open eyes,time to extubation),postoperative analgesic drug dosage and adverse events were compared between the two groups.Result At T_(3),the heart rate of the observation group was significantly lower than that of the routine group(P<0.01).At T_(2) and T_(3),the systolic blood pressure and diastolic blood pressure of the observation group were lower than those of the routine group(P<0.05).Immediately,12 h,24 h,and 48 h after the surgery,the VAS scores of the observation group were lower than those of the routine group;immediately,12 h,and 24 h after the surgery,the MMSE scores of the observation group were higher than those of the routine group,and the differences were statistically significant(P<0.05).After the surgery,the levels of Cor,MDA,E,and NE of the two groups were higher than those before the surgery,while the indicators of the observation group were lower than those of the routine group,and the differences were statistically significant(P<0.05).There were no significant differences in the time of eyeopening and extubation between the two groups(P>0.05).The Ricker Sedation-Agitation score of the observation group was significantly lower than that of the routine group,and the amount of sufentanil after surgery was significantly lower than that of the routine group,and the differences were statistically significant(P<0.01).There was no significant difference in the total incidence of adverse events between the two groups(P>0.05).Conclusion Intravenous dezocine anesthesia could maintain the stability of vital signs in patients undergoing laparoscopic gastric cancer surgery,effectively reduce postoperative restlessness during recovery,relieve postoperative pain,and reduce postoperative stress response,and the medication is safe.