地佐辛联合丙泊酚靶控输注处理接受内镜下注射硬化剂治疗的乙型肝炎肝硬化并发食管静脉曲张破裂出血患者麻醉苏醒和镇痛效果研究

Dezocine anesthesia induction and propofol target-controlled infusion maintaining in patients withliver cirrhosis and esophageal variceal bleeding underwent endoscopic sclerotherapy

目的探讨地佐辛联合丙泊酚靶控输注麻醉接受内镜下注射硬化剂治疗的乙型肝炎肝硬化并发食管静脉曲张破裂出血(EVB)患者麻醉苏醒和镇痛效果。方法2020年5月~2023年6月我院诊治的乙型肝炎肝硬化并发EVB患者64例,将患者分为两组,均接受丙泊酚靶控输注麻醉,观察组行地佐辛诱导麻醉。两组均接受内镜下聚桂醇注射硬化治疗。观察并记血液动力学指标,评估麻醉苏醒时间。采用疼痛视觉模拟评分(VAS)[10]评价镇痛效果。采用ELISA法检测血清神经肽Y(NPY)、P物质(SP)、去甲肾上腺素(NE)和多巴胺(DA)水平,常规检测血清总抗氧化能力(T-AOC)、超氧化物歧化酶(SOD)和丙二醛(MDA)水平。结果在麻醉诱导后和进镜时,观察组平均动脉压(MAP)和心率(HR)均显著高于或快于对照组(P<0.05);观察组丙泊酚用量为(461.3±14.1)mg,显著少于对照组【(482.9±15.8)mg,P<0.05】,苏醒时间为(5.1±1.3)min,显著短于对照组【(6.7±1.4)min,P<0.05】,两组躁动评分无显著性差异(P>0.05);在术后1 h和3 h时,观察组静态和动态VAS评分均显著低于对照组(P<0.05);在术后6 h时,观察组血清NPY、SP、DA和NE水平分别为(155.7±21.9)pg/mL、(2.6±0.6)g/mL、(71.6±11.2)mmol/L和(2.5±0.6)pg/mL,均显著低于对照组【分别为(189.3±22.8)pg/mL、(3.8±0.8)g/mL、(84.3±12.7)mmol/L和(3.9±0.5)pg/mL,P<0.05】;观察组血清SOD和T-AOC水平分别为(73.1±6.1)U/mL和(15.2±1.4)U/mL,显著高于对照组【分别为(64.2±5.7)U/mL和(12.0±1.1)U/mL,P<0.05】,而血清MDA水平为(3.7±0.6)mmol/L,显著低于对照组【(6.2±0.7)mmol/L,P<0.05】;观察组恶心呕吐发生率为3.1%,显著低于对照组的25.0%(P<0.05)。结论在行硬化剂注射治疗肝硬化并发EBV患者时,采用丙泊酚靶控输注麻醉前给予地佐辛诱导麻醉可能获得更好的镇痛效果,值得验证。

Objective The aim of this study was to investigate dezocine anesthesia induction and propofol target-controlled infusion maintaining in patients withliver cirrhosis(LC)and esophageal variceal bleeding(EVB)underwent endoscopic sclerotherapy.Methods 64 hepatitis B-induced LC patients with EVB encountered in our hospital underwent endoscopic lauromacrogol injection,and 32 patients were assigned to control and another 32 to observation group.For anesthesia,the propofol target-controlled infusion was maintained in the two groups,and dezocine induction was given in the observation,additionally.The postoperative pain was evaluated by visual analogue scale(VAS).Serum neuropeptide Y(NPY),substance P(SP),norepinephrine(NE)and dopamine(DA)levels were detected by ELISA,and serum total antioxidant capacity(T-AOC),superoxide dismutase(SOD)and malondialdehyde(MDA)levels were routinely assayed.Results The mean arterial pressure and heart rate at anesthesia induction and endoscopic insertion in the observation were significantly greater or quicker than in the control(P<0.05);the propofol dosage in the observation was(461.3±14.1)mg,much lower than[(482.9±15.8)mg,P<0.05],wake-up time was(5.1±1.3)min,much shorter than[(6.7±1.4)min,P<0.05]in the control,while there was no significant difference in restless scores between the two groups(P>0.05);at 1 hour and 3 hours after operation,the static and dynamic VAS scores in the observation were much lower than in the control(P<0.05);at the end of six hours after endoscopic sclerotherapy,serum NPY,SP,DA and NE levels in the observation were(155.7±21.9)pg/mL,(2.6±0.6)g/mL,(71.6±11.2)mmol/L and(2.5±0.6)pg/mL,all significantly lower than[(189.3±22.8)pg/mL,(3.8±0.8)g/mL,(84.3±12.7)mmol/L and(3.9±0.5)pg/mL,respectively,P<0.05]in the control;serum SOD and T-AOC levels were(73.1±6.1)U/mL and(15.2±1.4)U/mL,both significantly higher than[(64.2±5.7)U/mL and(12.0±1.1)U/mL,P<0.05],while serum MDA level was(3.7±0.6)mmol/L,significantly lower than[(6.2±0.7)mmol/L,P<0.05]in the control;the incidence of nausea and vomiting in the observation was 3.1%,much lower than 25.0%(P<0.05)in the control group.Conclusion During endoscopic sclerotherapy,the dezocine induction before propofol maintaining analgesia could improve the analgesic effects and decrease adverse events in patients with EVB,which might be related to the inhibition of oxidative stress.