中国保健营养（上旬刊）
中國保健營養（上旬刊）
중국보건영양（상순간）
China Health Care & Nutrition
2014年
1期
6-7
,共2页
地佐辛%腹腔镜手术%麻醉诱导%插管反应%术后镇痛
地佐辛%腹腔鏡手術%痳醉誘導%插管反應%術後鎮痛
지좌신%복강경수술%마취유도%삽관반응%술후진통
dezocine%Laparoscopic surgery%Induction of anesthesia%Intubation reaction%Postoperative analgesia
目的：观察在腹腔镜手术全身麻醉诱导时，应用地佐辛抑制气管插管反应的效果及术后镇痛泵镇痛效果和患者清醒程度的影响。方法选着腹腔镜手术的患者50例，年龄在22-50岁之间，随即分为地佐辛组（ D组）和芬太尼组（ F组），每组25例。两组患者均采用静吸复合全身麻醉。麻醉诱导：患者进入手术室后静脉注射咪达唑仑0．05mg/kg，D组静脉注射地佐辛0．2-0．3mg/kg，F组静脉注射芬太尼4-6ug/kg，患者出现睡意后静脉注射依托咪酯0．4mg/kg，维库溴铵0．12mg/kg，达到插管条件后经口明视下行气管内插管。麻醉维持：经两组电脑输液泵分别静脉泵注丙泊酚、瑞芬太尼、按需要间断静脉注射维库溴铵维持肌松。手术结束后接静脉电子泵。待达到拔管指证后拔出导管，并记录苏醒时间、拔出导管后恶心呕吐、呼吸抑制、寒战等不良反应。观察指标：分别观察记录两组患者麻醉诱导前（T0）气管插管时（T1）各时间段平均动脉压（MAP）、心率（HR）的变化，待患者清醒拔出气管导管后，分别在苏醒即刻（t0）、苏醒后1小时（t1）对两组患者分别进行视觉模拟镇痛评分（VAS）的、布氏舒适度评分（BCS）和Bamsay镇静评分。结果两组患者在气管插管时（T1）都很好的抑制了气管插管反应，但F组患者MAP、HR下降均比较明显，与D组相比较差异有统计学意义（P＜0．05）；两组患者苏醒时间和拔管时间比较无统计学意义（P＞0．05）；在苏醒即刻（t0），对两组患者进行视觉模拟镇痛评分（VAS）D组明显低于F组（P＜0．05），进行布氏舒适度评分（BCS） D组明显高于F组（P＜0．05）；在苏醒后1小时（t1）两组患者VAS、BCS评分比较差异无统计学意义（P＞0．05）。结论腹腔镜手术时应用地佐辛进行麻醉诱导可以达到足够的麻醉深度，对患者的插管应激反应起到了良好的抑制作用，并且在达到插管条件时对患者循环的影响较小，对患者的苏醒、拔管时间无明显影响，但拔管后患者表现嗜睡，拔管即刻患者镇痛评分较低与手术后镇痛泵起效时间连接更合理。
目的：觀察在腹腔鏡手術全身痳醉誘導時，應用地佐辛抑製氣管插管反應的效果及術後鎮痛泵鎮痛效果和患者清醒程度的影響。方法選著腹腔鏡手術的患者50例，年齡在22-50歲之間，隨即分為地佐辛組（ D組）和芬太尼組（ F組），每組25例。兩組患者均採用靜吸複閤全身痳醉。痳醉誘導：患者進入手術室後靜脈註射咪達唑崙0．05mg/kg，D組靜脈註射地佐辛0．2-0．3mg/kg，F組靜脈註射芬太尼4-6ug/kg，患者齣現睡意後靜脈註射依託咪酯0．4mg/kg，維庫溴銨0．12mg/kg，達到插管條件後經口明視下行氣管內插管。痳醉維持：經兩組電腦輸液泵分彆靜脈泵註丙泊酚、瑞芬太尼、按需要間斷靜脈註射維庫溴銨維持肌鬆。手術結束後接靜脈電子泵。待達到拔管指證後拔齣導管，併記錄囌醒時間、拔齣導管後噁心嘔吐、呼吸抑製、寒戰等不良反應。觀察指標：分彆觀察記錄兩組患者痳醉誘導前（T0）氣管插管時（T1）各時間段平均動脈壓（MAP）、心率（HR）的變化，待患者清醒拔齣氣管導管後，分彆在囌醒即刻（t0）、囌醒後1小時（t1）對兩組患者分彆進行視覺模擬鎮痛評分（VAS）的、佈氏舒適度評分（BCS）和Bamsay鎮靜評分。結果兩組患者在氣管插管時（T1）都很好的抑製瞭氣管插管反應，但F組患者MAP、HR下降均比較明顯，與D組相比較差異有統計學意義（P＜0．05）；兩組患者囌醒時間和拔管時間比較無統計學意義（P＞0．05）；在囌醒即刻（t0），對兩組患者進行視覺模擬鎮痛評分（VAS）D組明顯低于F組（P＜0．05），進行佈氏舒適度評分（BCS） D組明顯高于F組（P＜0．05）；在囌醒後1小時（t1）兩組患者VAS、BCS評分比較差異無統計學意義（P＞0．05）。結論腹腔鏡手術時應用地佐辛進行痳醉誘導可以達到足夠的痳醉深度，對患者的插管應激反應起到瞭良好的抑製作用，併且在達到插管條件時對患者循環的影響較小，對患者的囌醒、拔管時間無明顯影響，但拔管後患者錶現嗜睡，拔管即刻患者鎮痛評分較低與手術後鎮痛泵起效時間連接更閤理。
목적：관찰재복강경수술전신마취유도시，응용지좌신억제기관삽관반응적효과급술후진통빙진통효과화환자청성정도적영향。방법선착복강경수술적환자50례，년령재22-50세지간，수즉분위지좌신조（ D조）화분태니조（ F조），매조25례。량조환자균채용정흡복합전신마취。마취유도：환자진입수술실후정맥주사미체서륜0．05mg/kg，D조정맥주사지좌신0．2-0．3mg/kg，F조정맥주사분태니4-6ug/kg，환자출현수의후정맥주사의탁미지0．4mg/kg，유고추안0．12mg/kg，체도삽관조건후경구명시하행기관내삽관。마취유지：경량조전뇌수액빙분별정맥빙주병박분、서분태니、안수요간단정맥주사유고추안유지기송。수술결속후접정맥전자빙。대체도발관지증후발출도관，병기록소성시간、발출도관후악심구토、호흡억제、한전등불량반응。관찰지표：분별관찰기록량조환자마취유도전（T0）기관삽관시（T1）각시간단평균동맥압（MAP）、심솔（HR）적변화，대환자청성발출기관도관후，분별재소성즉각（t0）、소성후1소시（t1）대량조환자분별진행시각모의진통평분（VAS）적、포씨서괄도평분（BCS）화Bamsay진정평분。결과량조환자재기관삽관시（T1）도흔호적억제료기관삽관반응，단F조환자MAP、HR하강균비교명현，여D조상비교차이유통계학의의（P＜0．05）；량조환자소성시간화발관시간비교무통계학의의（P＞0．05）；재소성즉각（t0），대량조환자진행시각모의진통평분（VAS）D조명현저우F조（P＜0．05），진행포씨서괄도평분（BCS） D조명현고우F조（P＜0．05）；재소성후1소시（t1）량조환자VAS、BCS평분비교차이무통계학의의（P＞0．05）。결론복강경수술시응용지좌신진행마취유도가이체도족구적마취심도，대환자적삽관응격반응기도료량호적억제작용，병차재체도삽관조건시대환자순배적영향교소，대환자적소성、발관시간무명현영향，단발관후환자표현기수，발관즉각환자진통평분교저여수술후진통빙기효시간련접경합리。
Objective To observe the induction of general anesthesia in laparoscopic surgery ,the application of dezocine inhibiting effect of endotracheal intubation response and postoperative analgesia analgesic efficacy and patient awake extent.Methods 50 patients with laparoscopic surgery in patients aged 22 to 50 years old,were randomly divided into dezocine group(D group)and fentanyl group(F),n=25.Two groups of patients were treated with inhalation general anesthesia.Induction of anes-thesia:The patient enters the operating room after the intravenous injection of midazolam 0.05mg/kg,D group intravenous dezocine 0.2 -0.3mg/kg,F group,intrave-nous fentanyl 4-6ug/kg,drowsiness after patients intravenous etomidate 0.4mg/kg,vecuronium 0.12mg/kg,achieve intubating conditions after oral endotracheal intuba-tion photopic down.Maintenance of anesthesia:After two computers was intravenous infusion pump infusion of propofol ,remifentanil,according to need intermittent intra-venous injection of vecuronium to maintain muscle relaxation .At the end of surgery followed by intravenous electronic pump .Be reached after extubation testify remove the catheter and record recovery time;remove the catheter nausea,vomiting,respiratory depression,chills and other adverse reactions.OUTCOME MEASURES:Two groups of patients were observed and recorded before induction of anesthesia(T0)intubation(T1)each time period mean arterial pressure(MAP),heart rate(HR)chan-ges in the endotracheal tube to be removed after the patient awake,respectively,in awake instantly(t0),1 hour after awakening(t1)two groups of patients were on a visu-al analogue pain scale(VAS),and Brinell comfort score(BCS)and Bamsay sedation score.Results The patients in endotracheal intubation(T1)are very good suppression of tracheal intubation response,but the F group of patients MAP,HR decline were more obvious compared with the D group was significantly(P<0.05);patients were a-wake time and extubation time was not statistically significant(P>0.05);in the wake immediately(t0),two groups of patients with visual analog pain score(VAS)D was significantly lower than group F(P<0.05),Brinell comfort score(BCS)D group was significantly higher than the F group(P<0.05);in 1 hour after awakening(t1)pa-tients were VAS,BCS score difference was not statistically significant(P>0.05).Conclusion The application of laparoscopic surgery dezocine induction of anesthesia can achieve sufficient depth of anesthesia,the patient's stress response intubation played a good inhibition,and in the conditions to achieve intubation little effect on the circulation of patients,the patient awake extubation time had no significant effect,but after extubation patients showed lethargy,tracheal extubation in patients with post-operative pain scores were lower onset of analgesia pump connected to more reasonable .
