CAJ | 학술논문

目的评价罗哌卡因浸润麻醉联合地佐辛对颅脑外科手术患者全麻恢复期躁动的影响.方法择期行颅脑肿瘤切除术的患者60例,性别不限,年龄18～ 64岁,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为4组(n=15):对照组(C组)、罗哌卡因组(R组)、地佐辛组(D组)和罗哌卡因+地佐辛组(RD组).C组切皮前10 min用生理盐水20 ml行浸润麻醉(1∶200 000肾上腺素),手术结束前30 min静脉注射生理盐水2 ml.R组切皮前10 min用0.5％罗哌卡因20 ml行浸润麻醉,手术结束前30 min静脉注射生理盐水2 ml.D组切皮前10 min用生理盐水20 ml行浸润麻醉(1∶200 000肾上腺素),手术结束前30 min静脉注射地佐辛10 mg;RD组手术切皮前10 min用0.5％罗哌卡因20 ml行浸润麻醉,手术结束前30 min静脉注射地佐辛10 mg.记录麻醉恢复时间、气管拔管时间、PACU期间气管拔管后躁动的发生情况,并评价躁动程度.记录气管拔管后10 min内心血管事件和呼吸抑制的发生情况.分别于麻醉诱导前(T0)、术毕(T1)和拔除气管导管后即刻(T2),采集足背动脉血样,测定血糖、血浆皮质醇、肾上腺素和去甲肾上腺素的浓度.结果与C组比较,R组、D组和RD组躁动发生率和躁动程度降低,T1和T2时血糖浓度和血浆皮质醇、肾上腺素和去甲肾上腺素的浓度降低,高血压发生率降低,R组和RD组麻醉恢复时间和气管拔管时间缩短(P＜0.05).与R组和D组比较,RD组躁动发生率和躁动程度降低T1和T2时血糖浓度和血浆皮质醇、肾上腺素和去甲肾上腺素的浓度降低,高血压发生率降低(P＜0.05).结论罗哌卡因浸润麻醉联合地佐辛可降低颅脑外科手术患者全麻恢复期躁动的发生和程度.
목적 평개라고잡인침윤마취연합지좌신대로뇌외과수술환자전마회복기조동적영향.방법 택기행로뇌종류절제술적환자60례,성별불한,년령18～ 64세,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,장기분위4조(n=15):대조조(C조)、라고잡인조(R조)、지좌신조(D조)화라고잡인+지좌신조(RD조).C조절피전10 min용생리염수20 ml행침윤마취(1∶200 000신상선소),수술결속전30 min정맥주사생리염수2 ml.R조절피전10 min용0.5％라고잡인20 ml행침윤마취,수술결속전30 min정맥주사생리염수2 ml.D조절피전10 min용생리염수20 ml행침윤마취(1∶200 000신상선소),수술결속전30 min정맥주사지좌신10 mg;RD조수술절피전10 min용0.5％라고잡인20 ml행침윤마취,수술결속전30 min정맥주사지좌신10 mg.기록마취회복시간、기관발관시간、PACU기간기관발관후조동적발생정황,병평개조동정도.기록기관발관후10 min내심혈관사건화호흡억제적발생정황.분별우마취유도전(T0)、술필(T1)화발제기관도관후즉각(T2),채집족배동맥혈양,측정혈당、혈장피질순、신상선소화거갑신상선소적농도.결과 여C조비교,R조、D조화RD조조동발생솔화조동정도강저,T1화T2시혈당농도화혈장피질순、신상선소화거갑신상선소적농도강저,고혈압발생솔강저,R조화RD조마취회복시간화기관발관시간축단(P＜0.05).여R조화D조비교,RD조조동발생솔화조동정도강저T1화T2시혈당농도화혈장피질순、신상선소화거갑신상선소적농도강저,고혈압발생솔강저(P＜0.05).결론 라고잡인침윤마취연합지좌신가강저로뇌외과수술환자전마회복기조동적발생화정도.
Objective To investigate the effects of ropivacaine infiltration combined with dezocine on the agitation during recovery from general anesthesia in the patients undergoing cerebral surgery.Methods Sixty patients of both sexes,aged 18-64 yr,of ASA physical status Ⅰ or Ⅱ,undergoing elective neurosurgery under general anesthesia,were randomly divided into 4 groups (n =15 each) using a random number table:control group (group C),ropivacaine group (group R),dezocine group (group D),and ropivacaine + dezocine group (group RD).Group C received local infiltration with normal saline 20 ml at 10 min before skin incision,and normal saline 2 ml was injected intravenously at 30 min before the end of operation.The patients received local infiltration with 0.5％ ropivacaine 20 ml at 10 min before skin incision,and normal saline 2 ml was injected intravenously at 30 min before the end of operation in group R.Group D received local infiltration with normal saline 20 ml at 10 min before skin incision,and dezocine 10 mg was injected intravenously at 30 min before the end of operation.The patients received local infiltration with 0.5％ ropivacaine 20 ml at 10 min before skin incision,and dezocine 10 mg was injected intravenously at 30 min before the end of operation in group RD.The time for recovery from anesthesia,extubation time,and development of agitation after extubation in PACU were recorded.Agitation was assessed and scored.Ramsay sedation score and VAS score were recorded immediately after extubation.The development of cardiovascular events and respiratory depression was recorded within 10 min after extubation.Before induction of anesthesia (T0),at the end of surgery (T1) and immediately after extubation (T2),blood samples were collected from the dorsal artery of foot for deter mination of the levels of blood glucose,plasma cortisone,epinephrine and norepinephrine.Results Compared with group C,the agitation score,incidence of agitation,VAS score,and incidence of postoperative hypertension were significantly decreased in R,D and RD groups,especially in R and D groups.The time for recovery from anesthesia and time for extubation were significantly shorter in R and RD groups than in group C.Ramsay sedation scores were significantly higher at the onset of extubation in R,D and RD groups than in group C.Ramsay sedation scores were significantly higher in D and RD groups than in group R.Compared with group C,the levels of blood glucose,plasma cortisone,epinephrine and norepinephrine were significantly decreased in R,D and RD groups,especially in group RD.Conclusion Ropivacaine infiltration combined with dezocine can reduce the agitation during recovery from general anesthesia in the patients undergoing cerebral surgery.