地佐辛结合腰硬联合麻醉用于老年肛肠手术的镇痛镇静效果

Analgesic and sedative effect of dezocine combined with spinal-epidural anesthesia for anorectal surgery in the elderly

目的探讨地佐辛结合腰硬联合麻醉用于老年肛肠手术的镇痛镇静效果。方法选取2019年9月至2020年9月于福建省老年医院行肛肠手术的76例老年患者作为研究对象,采用随机数字表法分为对照组与观察组,每组38例。对照组采用腰硬联合麻醉,观察组采用地佐辛结合腰硬联合麻醉,比较两组不同时点血流动力学指标、视觉模拟评分法(VAS)评分、Ramsay镇静评分、炎症反应指标及麻醉后不良反应发生情况。结果切皮后5min、术毕时及术后1h,观察组心率慢于对照组,平均动脉压低于对照组,差异有统计学意义(P<0.05)。术后1、12、24h,观察组VAS、Ramsay镇静均评分高于对照组,差异有统计学意义(P<0.05)。术后1、12、24h,观察组白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平均低于对照组,差异有统计学意义(P<0.05)。观察组麻醉后不良反应发生率为7.89%,对照组为10.52%,两组比较差异无统计学意义。结论地佐辛结合腰硬联合麻醉用于老年肛肠手术患者的镇痛镇静效果较好,不仅能维持患者血流动力学指标稳定,减少机体炎症因子释放,还可减少麻醉后不良反应。

Objective To investigate the analgesic and sedative effect of dezocine combined with spinal-epidural anesthesia or anorectal surgery in the elderly.Methods A total of 76 elderly patients who underwent anorectal surgery in Fujian Geriatric Hospital from September 2019 to Septem-ber 2020 were selected as the study subjects,and they were divided into the control group and the observation group by random number table meth-od,with 38 cases in each group.The control group was treated with spinal-epidural anesthesia,and the observation group was treated with dezocine combined with spinal-epidural anesthesia,and the hemodynamic indexes,visual analogue score(VAS)score,Ramsay sedation score,inflammatory response indexes at different time,and the occurrence of adverse reactions after anesthesia were compared between the two groups.Results 5 min after skin incision,at the end of operation and 1 h after operation,the heart rate in the observation group was slower than that in the control group,and mean arterial pressure was lower than that in the control group,and the differences were statistically significant(P<0.05).At 1,12 and 24 h af-ter operation,the scores of VAS,Ramsay sedation in the observation group were higher than those in the control group,and the differences were sta-tistically significant(P<0.05).At 1,12 and 24 h after operation,the levels of IL-6 and TNF-αin the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The incidence of adverse reactions after anesthesia was 7.89%in the obser-vation group and 10.52%in the control group,and there was no significant difference between the two groups.Conclusion The analgesic and seda-tive effect of dezocine combined with spinal-epidural anesthesia has good analgesic and sedative effect in elderly anorectal surgery,which can not on-ly maintain the stability of hemodynamic indexes,reduce the release of inflammatory factors in the body,but also reduce the adverse reactions after anesthesia.