CAJ | 학술논문

目的评价地佐辛预防瑞芬太尼复合麻醉患者术后痛觉过敏的效果.方法择期行腹腔镜胆囊切除术患者100例,年龄20～64岁,体重45～65 kg,ASA分级Ⅰ或Ⅱ级,采用随机数学表法,将其随机分为4组(n=25):芬太尼组(F组)、低剂量地佐辛组(D1组)、中剂量地佐辛组(D2组)和高剂量地佐辛组(D3组).静脉注射咪达唑仑、异丙酚、瑞芬太尼和顺阿曲库铵麻醉诱导,气管内插管后机械通气.麻醉维持:靶控输注瑞芬太尼,效应室靶浓度4 μg/L,静脉输注异丙酚4～6 mg·kg-1·h-1,间断静脉注射顺阿曲库铵0.03 mg/kg.手术结束前30 min时D1组、D2组和D3组分别肌肉注射地佐辛0.1、0.2、0.3 mg/kg,F组手术结束前15 min静脉注射芬太尼1 μg/kg.记录苏醒时间、拔除气管导管时间,记录苏醒后即刻、1h、2 h(T0 ～ T2)时视觉模拟评分(VAS)、布氏舒适评分(BCS)和镇静和躁动评分(SAS),记录拔除气管导管后呼吸抑制、恶心呕吐及尿潴留的发生情况.结果与F组比较,D1组、D2组和D3组苏醒时间和拔除气管导管时间缩短,呼吸抑制和恶心呕吐发生率降低；D1组各时点VAS评分升高,BCS评分降低,D2组和D3组T0时VAS评分升高,T1,2时VAS评分降低,T0～2时SAS评分降低(P＜0.05)；与D2组比较,D3组T0～2时SAS评分降低,呼吸抑制发生率升高(P＜0.05)；4组无一例患者发生尿潴留.结论手术结束前30 min肌肉注射地佐辛0.2 mg/kg可减轻瑞芬太尼复合麻醉患者麻醉恢复期痛觉过敏,且副作用小.
목적 평개지좌신예방서분태니복합마취환자술후통각과민적효과.방법 택기행복강경담낭절제술환자100례,년령20～64세,체중45～65 kg,ASA분급Ⅰ혹Ⅱ급,채용수궤수학표법,장기수궤분위4조(n=25):분태니조(F조)、저제량지좌신조(D1조)、중제량지좌신조(D2조)화고제량지좌신조(D3조).정맥주사미체서륜、이병분、서분태니화순아곡고안마취유도,기관내삽관후궤계통기.마취유지:파공수주서분태니,효응실파농도4 μg/L,정맥수주이병분4～6 mg·kg-1·h-1,간단정맥주사순아곡고안0.03 mg/kg.수술결속전30 min시D1조、D2조화D3조분별기육주사지좌신0.1、0.2、0.3 mg/kg,F조수술결속전15 min정맥주사분태니1 μg/kg.기록소성시간、발제기관도관시간,기록소성후즉각、1h、2 h(T0 ～ T2)시시각모의평분(VAS)、포씨서괄평분(BCS)화진정화조동평분(SAS),기록발제기관도관후호흡억제、악심구토급뇨저류적발생정황.결과 여F조비교,D1조、D2조화D3조소성시간화발제기관도관시간축단,호흡억제화악심구토발생솔강저；D1조각시점VAS평분승고,BCS평분강저,D2조화D3조T0시VAS평분승고,T1,2시VAS평분강저,T0～2시SAS평분강저(P＜0.05)；여D2조비교,D3조T0～2시SAS평분강저,호흡억제발생솔승고(P＜0.05)；4조무일례환자발생뇨저류.결론 수술결속전30 min기육주사지좌신0.2 mg/kg가감경서분태니복합마취환자마취회복기통각과민,차부작용소.
Objective To evaluate the preventive effects of dezocine on postoperative hyperalgesia in patients after remifentanil-based anesthesia.Methods One hundred ASA Ⅰ or Ⅱ patients,aged 20-64,weighing 45-65 kg,undergoing laparoscopic cholecystectomy,were randomly divided into 4 groups ( n =25 each): fentanyl group (group F),low-dose dezocine group (group D1 ),medium-dose dezocine group (group D2 ) and high-dose dezocine group (group D3 ).Anesthesia was induced with midazolam,propofol,remifentanil and cisatracurium.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with target-controlled infusion of remifentanil (target effect-site concentration 4 μg/L), intravenous infusion of propofol 4-6mg· kg-1· h-1 and intermittent intravenous injection of cisatracurium 0.03 mg/kg.Groups D1,D2 and D3 received intramuscular injection of dezocine 0.1,0.2,0.3 mg/kg at 30 min before the end of surgery respectively and group F received intravenous injection of fentanyl 1 μg/kg at 15 min before the end of surgery.The emergence time and extubation time were recorded.Visual analog scale(VAS),Bruggrmann comfort scale(BCS) and sedation and agitation scale (SAS) at immediately,1 h,2 h after emergence from anesthesia (T0,1,2),and the incidence of respiratory depression,nausea and vomiting and urinary retention after extubation were recorded.Results Compared with group F,the emergence time and extubation time were shortened,the incidence of respiratory depression and nausea and vomiting was decreased in groups D1,D2 and D3,VAS score was increased and BCS score was decreased at T0-2 in group D1,VAS score at T0 was increased,while VAS score at T1,2 and SAS score at T0-2 was decreased in groups D2 and D3 ( P ＜ 0.05).Compared with group D2,SAS score was decreased at T0-2,while the incidence of respiratory depression was increased in group D3 ( P ＜ 0.05 ).No patient showed urinary retention in the four groups.Conclusion Intramuscular injection of dezocine 0.2 mg/kg at 30 min before the end of surgery can reduce postoperative hyperalgesia with little side effects in patients after remifentanil-based anesthesia.