CAJ | 학술논문

目的观察地佐辛对神经外科手术患者术后静脉自控镇痛（PCIA）疗效和血浆内皮素-1（内皮素-1）水平的影响。方法择期行神经外科手术患者60例，随机均分为三组：D组（地佐辛行PCIA）、F组（芬太尼行PCIA）、C组（未行PCIA），记录术后1、2、4、12和24 h的疼痛视觉模拟评分（VAS）、Ramsay镇静评分及不良反应，分别于麻醉前、术后1、2、4、12和24 h抽取静脉血，应用放射免疫法检测血浆内皮素-1的水平。结果 D组和F组患者术后各时间点VAS评分均明显低于C组，差异均有统计学意义（t分别=2.24、2.33、2.57、2.88、3.56、2.39、2.52、2.97、3.62、4.86， P均＜0.05），D组和F组各时间点Ramsay镇静评分均明显高于C组，差异均有统计学意义（t分别=1.82、2.13、2.49、2.39、2.86、2.21、2.38、2.69、2.92、3.48， P均＜0.05）。 D组头晕嗜睡、恶心呕吐发生率均低于F组，差异均有统计学意义（χ2分别=2.77、3.91， P均＜0.05）；术后2、4、12和24 h，C组的血浆内皮素-1水平明显高于D组和F组，差异均有统计学意义（t分别=1.64、1.90、2.25、3.52、2.02、2.58、3.17、4.21， P均＜0.05），术后12 h和24 h，D组血浆内皮素-1水平明显低于F组，差异均有统计学意义（t分别=1.66、1.89， P均＜0.05）。结论术毕前静脉输注地佐辛能有效抑制术后应激造成的血浆内皮素-1水平增高，镇痛效果好且不良反应少，适合于神经外科术后镇痛。
목적관찰지좌신대신경외과수술환자술후정맥자공진통（PCIA）료효화혈장내피소-1（내피소-1）수평적영향。방법택기행신경외과수술환자60례，수궤균분위삼조：D조（지좌신행PCIA）、F조（분태니행PCIA）、C조（미행PCIA），기록술후1、2、4、12화24 h적동통시각모의평분（VAS）、Ramsay진정평분급불량반응，분별우마취전、술후1、2、4、12화24 h추취정맥혈，응용방사면역법검측혈장내피소-1적수평。결과 D조화F조환자술후각시간점VAS평분균명현저우C조，차이균유통계학의의（t분별=2.24、2.33、2.57、2.88、3.56、2.39、2.52、2.97、3.62、4.86， P균＜0.05），D조화F조각시간점Ramsay진정평분균명현고우C조，차이균유통계학의의（t분별=1.82、2.13、2.49、2.39、2.86、2.21、2.38、2.69、2.92、3.48， P균＜0.05）。 D조두훈기수、악심구토발생솔균저우F조，차이균유통계학의의（χ2분별=2.77、3.91， P균＜0.05）；술후2、4、12화24 h，C조적혈장내피소-1수평명현고우D조화F조，차이균유통계학의의（t분별=1.64、1.90、2.25、3.52、2.02、2.58、3.17、4.21， P균＜0.05），술후12 h화24 h，D조혈장내피소-1수평명현저우F조，차이균유통계학의의（t분별=1.66、1.89， P균＜0.05）。결론술필전정맥수주지좌신능유효억제술후응격조성적혈장내피소-1수평증고，진통효과호차불량반응소，괄합우신경외과술후진통。
Objective To observe the effects of dezocine on patient-controlled intravenous analgesia and serum ET-1 level in neurosurgery patients. Methods Sixty patients who underwent neurosurgery surgery were randomly assigned into three groups:group D(PCIA with dezocine), group F(PCIA with fentanyl) and group C(did not do PCIA). The VAS scores and Ramsay sedation score at 1 hour, 2 hours, 4 hours, 12 hours and 24 hours after operation were assessed and adverse reaction were recorded. The serum ET-1 level was detected by radioimmunoassay. Results VAS scores of group D and group F at 1 hour, 2 hours, 4 hours, 12 hours and 24 hours after operation were significantly lower than those of groups C (t=2.24, 2.33, 2.57, 2.88, 3.56, 2.39, 2.52, 2.97, 3.62, 4.86, P<0.05). Ramsay sedation score of group D and group F at 1 hour, 2 hours, 4 hours, 12 hours and 24 hours after operation were significantly higher than those of groups C(t=1.82, 2.13, 2.49, 2.39, 2.86, 2.21, 2.38, 2.69, 2.92, 3.48, P<0.05). The incidence of dizziness and drowsiness, nausea and vomiting of group D were significantly lower than those of group F (χ2=2.77, 3.91, P<0.05). The serum ET-1 level of groups C at 2 hours, 4 hours, 12 hours and 24 hours after operation were significantly higher than those of group D and group F (t=1.64, 1.90, 2.25, 3.52, 2.02, 2.58, 3.17, 4.21, P<0.05). The serum ET-1 level of groups D at 12 hours and 24 hours after operation were significantly lower than that of group F(t=1.66, 1.89, P<0.05). Conclusion Intravenous in-fusion of dezocine before surgery completed can effectively inhibited the ET-1 levels increasing which was induced by postop-erative stress and it has good analgesia effect and few adverse reactions. It is suitable for neurosurgical postoperative analgesia.