CAJ | 학술논문

目的探讨地佐辛超前镇痛对显微血管减压术(microvascular decompression,MVD)治疗面肌痉挛苏醒期的影响.方法 32例择期行MVD治疗面肌痉挛手术患者,按随机数字表法分为实验组(Ⅰ组)和对照组(Ⅱ组),每组16例:Ⅰ组术毕前30 min静注5 mg/2 ml地佐辛；Ⅱ组术毕前30 min静注2ml生理盐水.观察术后苏醒时间、拔出喉罩后10 min疼痛视觉模拟评分(visual analogue scale,VAS)、Ramsay镇静评分及拔出喉罩即刻躁动评分(riker agitation-sedation scale,RSS)及麻醉前(T0,基础值)、拔出喉罩前5min(T1)、拔出喉罩即刻(T2)、拔出喉罩后10min(T3)时平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、脉搏血氧饱和度(pulse oxygen saturation,SpO2).结果术后苏醒时间、Ramsay镇静评分,Ⅰ组与Ⅱ组之间差异无统计学意义(P＞0.05)；Ⅰ组与Ⅱ组之间在T2 RSS评分[(0.62±0.11),(2.83±0.24)分]及在T3VAS评分[(1.04±0.22),(3.30±0.41)分]之间比较差异有统计学意义(P＜0.05)；MAP、HR,Ⅰ组与Ⅱ组之间T0和T1差异无统计学意义(p＞0.05),Ⅰ组T2和T3 MAP[(96.6±1.1),(94.7±1.1) mmHg(1 mmHg=0.133 kPa)]、HR[(81.4±1.7),(78.0±1.2)次/min]与Ⅱ组T2和T3 MAP[(104.9±1.5)、(100.9±1.2) mmHg]、HR[(87.7±2.0)、(85.0±1.9)次/min]比较,差异有统计学意义(P＜0.05).Ⅱ组内T2和T3 MAP[(104.9±1.5)、(100.9±1.2) mmHg]、HR[(87.7±2.0)、(85.0±1.9) 次/min]与T0MAP[(95.5±2.0) mmHg]、HR[(81.8±2.6)次/min]比较,差异有统计学意义(P＜0.05),Sp02两组比较差异无统计学意义(P＞0.05).两组患者在苏醒期阶段均无发生呼吸抑制、恶心呕吐、畏寒发热等并发症.结论地佐辛超前镇痛能够有效减轻MVD治疗面肌痉挛苏醒期的疼痛、降低拔喉罩即刻躁动发生率及维持苏醒期血流动力学的稳定.
목적 탐토지좌신초전진통대현미혈관감압술(microvascular decompression,MVD)치료면기경련소성기적영향.방법 32례택기행MVD치료면기경련수술환자,안수궤수자표법분위실험조(Ⅰ조)화대조조(Ⅱ조),매조16례:Ⅰ조술필전30 min정주5 mg/2 ml지좌신；Ⅱ조술필전30 min정주2ml생리염수.관찰술후소성시간、발출후조후10 min동통시각모의평분(visual analogue scale,VAS)、Ramsay진정평분급발출후조즉각조동평분(riker agitation-sedation scale,RSS)급마취전(T0,기출치)、발출후조전5min(T1)、발출후조즉각(T2)、발출후조후10min(T3)시평균동맥압(mean arterial pressure,MAP)、심솔(heart rate,HR)、맥박혈양포화도(pulse oxygen saturation,SpO2).결과 술후소성시간、Ramsay진정평분,Ⅰ조여Ⅱ조지간차이무통계학의의(P＞0.05)；Ⅰ조여Ⅱ조지간재T2 RSS평분[(0.62±0.11),(2.83±0.24)분]급재T3VAS평분[(1.04±0.22),(3.30±0.41)분]지간비교차이유통계학의의(P＜0.05)；MAP、HR,Ⅰ조여Ⅱ조지간T0화T1차이무통계학의의(p＞0.05),Ⅰ조T2화T3 MAP[(96.6±1.1),(94.7±1.1) mmHg(1 mmHg=0.133 kPa)]、HR[(81.4±1.7),(78.0±1.2)차/min]여Ⅱ조T2화T3 MAP[(104.9±1.5)、(100.9±1.2) mmHg]、HR[(87.7±2.0)、(85.0±1.9)차/min]비교,차이유통계학의의(P＜0.05).Ⅱ조내T2화T3 MAP[(104.9±1.5)、(100.9±1.2) mmHg]、HR[(87.7±2.0)、(85.0±1.9) 차/min]여T0MAP[(95.5±2.0) mmHg]、HR[(81.8±2.6)차/min]비교,차이유통계학의의(P＜0.05),Sp02량조비교차이무통계학의의(P＞0.05).량조환자재소성기계단균무발생호흡억제、악심구토、외한발열등병발증.결론 지좌신초전진통능구유효감경MVD치료면기경련소성기적동통、강저발후조즉각조동발생솔급유지소성기혈류동역학적은정.
Objective To explore effect of dezocine preemptive analgesia on microvascular decompression (MVD) for hemifacial spasm in anesthesia recovery period.Methods Thirty-two patients,who underwent the MVD for hemifacial spasm,were randomly divided into experimental group (group Ⅰ) and control group (group Ⅱ) with 16 patients per group.In group Ⅰ,patients received intravenous injection of dezocine 5 mg/2 ml 30 min before the end of the surgery.While in group Ⅱ,patients received intravenous injection of saline 2 ml 30 min before the end of the surgery.Postoperative recovery time,pain visual analogue scale (VAS) 10 min after extubation and pulling out laryngeal mask immediately riker agitation-sedation scale (RSS) were assessed.Mean arterial pressure (MAP),heart rate (HR) and pulse oxygen saturation(SpO2) were observed before anesthesia (T0,baseline),5 min before pulling out the laryngeal mask (T1),extracting the laryngeal mask immediately (T2) and 10 min after pulling out the laryngeal mask(T3).Results There was no significant difference in postoperative recovery time and Ramsay sedation score between group Ⅰ and group Ⅱ (P＞0.05).Significant difference between group Ⅰ and group Ⅱ in RSS score at T2 [(0.6±0.1),(2.8±0.2) points] and VAS score at T3 [(1.0±0.2),(3.3±0.4) points] were observed.There was no significant difference in MAP and HR at T0 and T1 between group Ⅰ and group Ⅱ (P＞0.05).From our results,it showed significant differences between group Ⅰ in MAP[(96.6±1.1),(94.7±1.1) mmHg(1 mmHg=0.133 kPa)],HR[(81.4±1.7),(78.0±1.2) bpm] and group Ⅱ in MAP[(104.9±1.5),(100.9±1.2) mmHg],HR[(87.7±2.0),(85.0±1.9) bpm] at T2 and T3.The MAP[(95.5±2.0) mmHg] and HR[(81.8±2.6) bpm] at T0 were compared with T2 and T3 in MAP[(104.9±1.5),(100.9±1.2) mmHg],HR[(87.7±2.0),(85.0±1.9) bpm] in group Ⅱ,which showed significant difference (P＜0.05).There was no significant difference in SpO2 (P＞0.05).No differences were observed in the complications in recovery stage,such as respiratory depression,nausea and vomiting,chills and fever between the two groups.Conclusions Dezocine for preemptive analgesia can effectively relieve postoperative pain,reduce the incidence of pulling laryngeal mask immediately agitation and maintain hemodynamic stability in the recovery period of patients with MVD for hemifacial spasm.