中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2014年
11期
1130-1133
,共4页
刘峰%刘秀珍%王恒林%吕一冬
劉峰%劉秀珍%王恆林%呂一鼕
류봉%류수진%왕항림%려일동
地佐辛%芬太尼%肾移植%超前镇痛
地佐辛%芬太尼%腎移植%超前鎮痛
지좌신%분태니%신이식%초전진통
Dezocine%Fentanyl%Renal transplantation%Preemptive analgesia
目的 通过观察肾移植患者术中应用地佐辛联合芬太尼麻醉对麻醉效果和苏醒质量的影响,探讨地佐辛在肾移植麻醉中的超前镇痛作用.方法 接受同种异体肾移植的患者80例,随机分为芬太尼组和地佐辛组,每组各40例.两组患者麻醉诱导均给予咪唑安定0.05 mg/kg、丙泊酚1～2 mg/kg、芬太尼3 μg/kg、顺苯磺酸阿曲库胺2.5 mg/kg静脉推注,肌松药起效后行气管插管,机械控制呼吸.麻醉维持采用静吸复合的方法,1％ ～2％七氟醚至手术结束前半小时停止吸入,静脉持续泵注1％丙泊酚3 ～5 mg/(kg·h)和盐酸瑞芬太尼0.1～0.2 μg/(kg·min)至手术结束.芬太尼组于切皮前常规静脉注射芬太尼2 μg/kg,地佐辛组于切皮前静脉注射地佐辛0.1 mg/kg,术中根据麻醉深度调整七氟醚吸入浓度和瑞芬太尼泵注速度.观察并记录患者麻醉前(T0)、切皮前(T1)、切皮后5 min(T2),拔管前5 min(T3)及拔管后10 min(T4)的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)各参数的变化和患者手术后拔管时间及苏醒期恶心、呕吐等不良反应的发生率;出手术室前采用模拟疼痛评分表评估患者疼痛情况.结果 两组患者MAP、心率、SpO2各时间段比较差异均无统计学意义(P均＞0.05);出手术室前模拟疼痛评分两组比较差异无统计学意义[芬太尼组:(1.76±0.43)分,地佐辛组:(1.84±0.57)分,P =0.480 7];与芬太尼组比较,地佐辛组苏醒期恶心、呕吐的不良反应发生率明显降低[芬太尼组为22.5％,地佐辛组为2.5％,x2=7.314 3,P=0.007];手术后拔管时间明显缩短[芬太尼组为(15.15±2.25) min,地佐辛组为(12.21±2.16) min,P=0.000].结论 地佐辛超前镇痛用于肾移植患者麻醉,可明显缩短拔管时间,降低苏醒期恶心、呕吐的发生率,可安全应用于肾移植患者的麻醉.
目的 通過觀察腎移植患者術中應用地佐辛聯閤芬太尼痳醉對痳醉效果和囌醒質量的影響,探討地佐辛在腎移植痳醉中的超前鎮痛作用.方法 接受同種異體腎移植的患者80例,隨機分為芬太尼組和地佐辛組,每組各40例.兩組患者痳醉誘導均給予咪唑安定0.05 mg/kg、丙泊酚1～2 mg/kg、芬太尼3 μg/kg、順苯磺痠阿麯庫胺2.5 mg/kg靜脈推註,肌鬆藥起效後行氣管插管,機械控製呼吸.痳醉維持採用靜吸複閤的方法,1％ ～2％七氟醚至手術結束前半小時停止吸入,靜脈持續泵註1％丙泊酚3 ～5 mg/(kg·h)和鹽痠瑞芬太尼0.1～0.2 μg/(kg·min)至手術結束.芬太尼組于切皮前常規靜脈註射芬太尼2 μg/kg,地佐辛組于切皮前靜脈註射地佐辛0.1 mg/kg,術中根據痳醉深度調整七氟醚吸入濃度和瑞芬太尼泵註速度.觀察併記錄患者痳醉前(T0)、切皮前(T1)、切皮後5 min(T2),拔管前5 min(T3)及拔管後10 min(T4)的平均動脈壓(MAP)、心率(HR)、脈搏血氧飽和度(SpO2)各參數的變化和患者手術後拔管時間及囌醒期噁心、嘔吐等不良反應的髮生率;齣手術室前採用模擬疼痛評分錶評估患者疼痛情況.結果 兩組患者MAP、心率、SpO2各時間段比較差異均無統計學意義(P均＞0.05);齣手術室前模擬疼痛評分兩組比較差異無統計學意義[芬太尼組:(1.76±0.43)分,地佐辛組:(1.84±0.57)分,P =0.480 7];與芬太尼組比較,地佐辛組囌醒期噁心、嘔吐的不良反應髮生率明顯降低[芬太尼組為22.5％,地佐辛組為2.5％,x2=7.314 3,P=0.007];手術後拔管時間明顯縮短[芬太尼組為(15.15±2.25) min,地佐辛組為(12.21±2.16) min,P=0.000].結論 地佐辛超前鎮痛用于腎移植患者痳醉,可明顯縮短拔管時間,降低囌醒期噁心、嘔吐的髮生率,可安全應用于腎移植患者的痳醉.
목적 통과관찰신이식환자술중응용지좌신연합분태니마취대마취효과화소성질량적영향,탐토지좌신재신이식마취중적초전진통작용.방법 접수동충이체신이식적환자80례,수궤분위분태니조화지좌신조,매조각40례.량조환자마취유도균급여미서안정0.05 mg/kg、병박분1～2 mg/kg、분태니3 μg/kg、순분광산아곡고알2.5 mg/kg정맥추주,기송약기효후행기관삽관,궤계공제호흡.마취유지채용정흡복합적방법,1％ ～2％칠불미지수술결속전반소시정지흡입,정맥지속빙주1％병박분3 ～5 mg/(kg·h)화염산서분태니0.1～0.2 μg/(kg·min)지수술결속.분태니조우절피전상규정맥주사분태니2 μg/kg,지좌신조우절피전정맥주사지좌신0.1 mg/kg,술중근거마취심도조정칠불미흡입농도화서분태니빙주속도.관찰병기록환자마취전(T0)、절피전(T1)、절피후5 min(T2),발관전5 min(T3)급발관후10 min(T4)적평균동맥압(MAP)、심솔(HR)、맥박혈양포화도(SpO2)각삼수적변화화환자수술후발관시간급소성기악심、구토등불량반응적발생솔;출수술실전채용모의동통평분표평고환자동통정황.결과 량조환자MAP、심솔、SpO2각시간단비교차이균무통계학의의(P균＞0.05);출수술실전모의동통평분량조비교차이무통계학의의[분태니조:(1.76±0.43)분,지좌신조:(1.84±0.57)분,P =0.480 7];여분태니조비교,지좌신조소성기악심、구토적불량반응발생솔명현강저[분태니조위22.5％,지좌신조위2.5％,x2=7.314 3,P=0.007];수술후발관시간명현축단[분태니조위(15.15±2.25) min,지좌신조위(12.21±2.16) min,P=0.000].결론 지좌신초전진통용우신이식환자마취,가명현축단발관시간,강저소성기악심、구토적발생솔,가안전응용우신이식환자적마취.
Objective To investigate the effect of dezocine combined with fentanyl in patients undergoing kidney transplantation on the quality of anesthesia and recover consciousness,as well as explore the preemptive analgesia effect of dezocine in renal transplantation.Methods Eighty patients undergoing allogeneic renal transplantation were randomly divided into control group (Ⅰ) and dezocine group (Ⅱ) (40 cases for each group).Patients in two groups were induced with midazolam 0.05 mg/kg,propofol 1-2 mg/kg,fentanyl 3 μg/kg,and cis-atracurium 2.5 mg/kg intravenously,and then they were incubated and given mechanical ventilation.Anesthesia was maintained with intravenous and inhalational anesthesia.1％-2％ sevoflurane had been inhaled until half an hour before the end of the surgery,while 1％ propofol 3-5 mg/kg/h and remifentanil 0.1-0.2 μg/kg/min had been pumped intravenously till the end of the surgery.2μg/kg fentanyl was infused in control group,while in dezocine group 0.1 mg/kg dezocine was intravenously infused before skin incision.The concentration of sevoflurane and the pump speed ofremifentanil were adjusted according to the depth of anesthesia.Changes of mean arterial pressure (MAP),heart rate (HR) and the pulse oximetry (SPO2) before anesthesia (T0),before skin incision (T1),5 minutes after incision (T2),5 minutes before extubation (T3) and 10 minutes after extubation(T4) were recorded.Extubation time,nausea,vomiting and the incidence of adverse reactions during recovery period were also recorded.Before leaving the operating room,VAS scale was used to assess the pain situation of patients.Results There were no significant differences in terms of MAP,HR and SPO2 at each time point between two groups (P ＞ 0.05).The VAS scores in fentanyl group was 1.76 ± 0.43,as same as that in dezocine group (1.84 ± 0.57,P =0.480 7).The incidence of adverse reactions including nausea,vomiting in fentanyl group and dezocine group were 22.5％ and 2.5％,and the difference was significant (x2 =7.314 3,P =0.007).The extubationtime after surgery in diesoline group [(12.21 ± 2.16) min] was significantly shortened than that in fentanyl group [(15.15 ± 2.25) min],P =0.000).Conclusion Dezocine preemptive analgesia is used in renal transplant patients in advance,and it can partly replace the same effect of fentanyl analgesia intensity,significantly shorten the extubation time,reduce the occurrence of awakening period adverse events such as of nausea,vomiting and restlessness.It is safe for renal transplant patients.
