CAJ | 학술논문

目的研究地佐辛联合帕瑞昔布钠经静脉注射在垂直斜视的斜视矫正术中局部麻醉的镇痛效果.方法选取山东省眼科研究所择期行斜视矫正术的垂直斜视患者80例,完全随机分为4组,每组20例,分别于术前15 min经静脉注射注射用帕瑞昔布钠40 mg(P组)、注射用地佐辛5 mg(D组)、注射用帕瑞昔布钠20 mg+注射用地佐辛2.5 mg(PD组)、注射用等剂量0.9％氯化钠注射液(N组).观察患者在术中5 min(T1)、术中15 min(T2)、术毕前5 min(T3)、术后2 h(T4)的疼痛数字模拟评分(NRS)、眼心反射及恶心呕吐、出汗等不良反应.因行上斜肌及下直肌手术的例数较少,故未对其在不同用药组间的NRS及眼心反射发生情况行统计学分析.结果 T1时点P、D、PD组NRS均较N组低,差异有统计学意义[(2.3±0.9)、(2.4±0.8)、(0.8±0.7)分比(5.2±0.7)分](P＜0.05);PD组NRS较P、D组低,差异有统计学意义(P＜0.05);P、D组间差异无统计学意义(P＞0.05).P组和D组患者各有1例呕吐,PD组患者无呕吐,N组患者发生呕吐3例(15.0％),但组间差异无统计学意义(P＞0.05).T2时点P、D、PD组NRS均较N组低[(3.2±1.1)、(2.4±0.7)、(1.5±0.8)分比(6.9±1.0)分],PD组NRS较P、D组低,D组NRS较P组低,差异均有统计学意义(均P＜0.05).4组间恶心呕吐症状,N组较P、D、PD组明显,差异有统计学意义(P＜0.05);P、D组较PD组明显,差异均有统计学意义(均P＜0.05);P、D组差异无统计学意义(P＞0.05).T3时点P、D、PD组NRS均较N组低,差异有统计学意义[(0.9±0.5)、(0.7±0.4)、(0.3±0.4)分比(1.9±0.9)分](P＜0.05);P、D、PD组间差异无统计学意义(P＞0.05).4组间恶心呕吐症状,N组较P、D、PD 3组明显,差异有统计学意义(P＜0.05);P、D、PD组间差异无统计学意义(P＞0.05).T4时点4组间NRS差异无统计学意义(P＞0.05).4组间恶心呕吐症状,N组较P、D、PD组明显,但各组各项观察指标差异均无统计学意义(均P＞0.05).上直肌与下斜肌眼心反射阳性率差异无统计学意义(P＞0.05).上直肌或下斜肌手术时眼心反射发生率及程度与NRS基本相同(P＞0.05).结论成人局部麻醉下垂直斜视矫正术采用地佐辛联合帕瑞昔布钠超前镇痛,具有良好的术中和术后镇痛效果,并能明显减轻术后恶心呕吐症状. 目的研究地佐辛聯閤帕瑞昔佈鈉經靜脈註射在垂直斜視的斜視矯正術中跼部痳醉的鎮痛效果.方法選取山東省眼科研究所擇期行斜視矯正術的垂直斜視患者80例,完全隨機分為4組,每組20例,分彆于術前15 min經靜脈註射註射用帕瑞昔佈鈉40 mg(P組)、註射用地佐辛5 mg(D組)、註射用帕瑞昔佈鈉20 mg+註射用地佐辛2.5 mg(PD組)、註射用等劑量0.9％氯化鈉註射液(N組).觀察患者在術中5 min(T1)、術中15 min(T2)、術畢前5 min(T3)、術後2 h(T4)的疼痛數字模擬評分(NRS)、眼心反射及噁心嘔吐、齣汗等不良反應.因行上斜肌及下直肌手術的例數較少,故未對其在不同用藥組間的NRS及眼心反射髮生情況行統計學分析.結果 T1時點P、D、PD組NRS均較N組低,差異有統計學意義[(2.3±0.9)、(2.4±0.8)、(0.8±0.7)分比(5.2±0.7)分](P＜0.05);PD組NRS較P、D組低,差異有統計學意義(P＜0.05);P、D組間差異無統計學意義(P＞0.05).P組和D組患者各有1例嘔吐,PD組患者無嘔吐,N組患者髮生嘔吐3例(15.0％),但組間差異無統計學意義(P＞0.05).T2時點P、D、PD組NRS均較N組低[(3.2±1.1)、(2.4±0.7)、(1.5±0.8)分比(6.9±1.0)分],PD組NRS較P、D組低,D組NRS較P組低,差異均有統計學意義(均P＜0.05).4組間噁心嘔吐癥狀,N組較P、D、PD組明顯,差異有統計學意義(P＜0.05);P、D組較PD組明顯,差異均有統計學意義(均P＜0.05);P、D組差異無統計學意義(P＞0.05).T3時點P、D、PD組NRS均較N組低,差異有統計學意義[(0.9±0.5)、(0.7±0.4)、(0.3±0.4)分比(1.9±0.9)分](P＜0.05);P、D、PD組間差異無統計學意義(P＞0.05).4組間噁心嘔吐癥狀,N組較P、D、PD 3組明顯,差異有統計學意義(P＜0.05);P、D、PD組間差異無統計學意義(P＞0.05).T4時點4組間NRS差異無統計學意義(P＞0.05).4組間噁心嘔吐癥狀,N組較P、D、PD組明顯,但各組各項觀察指標差異均無統計學意義(均P＞0.05).上直肌與下斜肌眼心反射暘性率差異無統計學意義(P＞0.05).上直肌或下斜肌手術時眼心反射髮生率及程度與NRS基本相同(P＞0.05).結論成人跼部痳醉下垂直斜視矯正術採用地佐辛聯閤帕瑞昔佈鈉超前鎮痛,具有良好的術中和術後鎮痛效果,併能明顯減輕術後噁心嘔吐癥狀.
목적 연구지좌신연합파서석포납경정맥주사재수직사시적사시교정술중국부마취적진통효과.방법 선취산동성안과연구소택기행사시교정술적수직사시환자80례,완전수궤분위4조,매조20례,분별우술전15 min경정맥주사주사용파서석포납40 mg(P조)、주사용지좌신5 mg(D조)、주사용파서석포납20 mg+주사용지좌신2.5 mg(PD조)、주사용등제량0.9％록화납주사액(N조).관찰환자재술중5 min(T1)、술중15 min(T2)、술필전5 min(T3)、술후2 h(T4)적동통수자모의평분(NRS)、안심반사급악심구토、출한등불량반응.인행상사기급하직기수술적례수교소,고미대기재불동용약조간적NRS급안심반사발생정황행통계학분석.결과 T1시점P、D、PD조NRS균교N조저,차이유통계학의의[(2.3±0.9)、(2.4±0.8)、(0.8±0.7)분비(5.2±0.7)분](P＜0.05);PD조NRS교P、D조저,차이유통계학의의(P＜0.05);P、D조간차이무통계학의의(P＞0.05).P조화D조환자각유1례구토,PD조환자무구토,N조환자발생구토3례(15.0％),단조간차이무통계학의의(P＞0.05).T2시점P、D、PD조NRS균교N조저[(3.2±1.1)、(2.4±0.7)、(1.5±0.8)분비(6.9±1.0)분],PD조NRS교P、D조저,D조NRS교P조저,차이균유통계학의의(균P＜0.05).4조간악심구토증상,N조교P、D、PD조명현,차이유통계학의의(P＜0.05);P、D조교PD조명현,차이균유통계학의의(균P＜0.05);P、D조차이무통계학의의(P＞0.05).T3시점P、D、PD조NRS균교N조저,차이유통계학의의[(0.9±0.5)、(0.7±0.4)、(0.3±0.4)분비(1.9±0.9)분](P＜0.05);P、D、PD조간차이무통계학의의(P＞0.05).4조간악심구토증상,N조교P、D、PD 3조명현,차이유통계학의의(P＜0.05);P、D、PD조간차이무통계학의의(P＞0.05).T4시점4조간NRS차이무통계학의의(P＞0.05).4조간악심구토증상,N조교P、D、PD조명현,단각조각항관찰지표차이균무통계학의의(균P＞0.05).상직기여하사기안심반사양성솔차이무통계학의의(P＞0.05).상직기혹하사기수술시안심반사발생솔급정도여NRS기본상동(P＞0.05).결론 성인국부마취하수직사시교정술채용지좌신연합파서석포납초전진통,구유량호적술중화술후진통효과,병능명현감경술후악심구토증상.
Objective To study the analgesic effect of intravenous dezocine combined with parecoxib sodium during vertical deviation surgery under local anesthesia,and to explore an effective and safe analgesia method.Methods This was a prospective and randomized study.80 vertical deviation patients electively undergoing strabismus surgery under local anesthesia in thie hospital were randomly allocated to 4 groups (20 cases in each group):group P received intravenous parecoxib sodium (40 mg) ; group D received intravenous dezocine (5 mg) ; group PD received intravenous parecoxib sodium (20 mg) + intravenous dezocine (2.5 mg) ; group N received intravenous isodose normal saline.All patients received the drug at 15 min before surgery.The indexes including numeric rating scales(NRS),culocardiacreflex (OCR),and adverse reactions such as nausea,vomiting and sweating were observed and separately recorded at 5 min in operation(T1),15 min in operation(T2),5 min before the end of operation(T3),and 2 h after operation (T4).Results The NRS scores at T1 were significantly lower in groups P,D than in group N [(2.3 ± 0.9),(2.4 ± 0.8),(0.8 ± 0.7) scores vs (5.2 ± 0.7) scores] (P ＜ 0.05) and group PD (P ＜ 0.05).Nausea,vomiting and sweating at T1 were not significantly different among the 4 groups.The NRS scores at T2 were significantly lower in group PD than in group D (P ＜ 0.05).The nausea and vomiting were significantly higher in group N than in group PD (P ＜ 0.05) and group PD than in group P and D [(3.2±1.1),(2.4±0.7),(1.5±0.8)scores vs (6.9±1.0)scores](P＜0.05),but they were not significantly different between group P and D.The NRS scores in groups N at T3 were significantly higher than in groups P,DandPD [(0.9±0.5),(0.7±0.4),(0.3±0.4)scores vs (1.9±0.9)scores](P＜0.05).Nausea and vomiting were significantly higher in group N than in groups P,D and PD(P ＜ 0.05).At T4,nausea and vomiting were higher in group N than in groups P,D and PD,but they were not significantly different.The NRS scores were not significantly different among the 4 groups.Superior rectus muscle was not different from inferior oblique muscle.The OCR and NRS scores between superior rectus muscle and inferior oblique muscle were basically the same.Conclusion Preemptive analgesia with dezocine combined with parecoxib sodium for vertical deviation surgery under local anesthesia is effective and can reduce the postoperative nausea and vomiting.