目的 观察地佐辛联合舒芬太尼用于腹腔镜手术患者术后静脉自控镇痛(PCIA)的效果及对血清5-羟色胺和P物质的影响.方法 将2014年510月于湖北省黄石市第二医院择期行腹腔镜手术患者60例完全随机分为地佐辛组(20例)、舒芬太尼组(20例)和联合用药组(20例).地佐辛组使用地佐辛0.6 mg/kg,舒芬太尼组使用舒芬太尼2μg/kg,联合用药组使用地佐辛0.3 mg/kg±舒芬太尼1μg/kg,各组泵中均加入托烷司琼5 mg及0.9％氯化钠注射液配制至100 ml.记录3组术后6、12、24、48 h的疼痛视觉模拟量表(VAS)评分、Ramsay镇静评分,48 h内患者PCIA有效按压次数及不良反应.检测麻醉前及术后12、24、48 h血清5-羟色胺和P物质浓度.结果 联合用药组患者术后6、12、24 h VAS评分、Ramsay镇静评分明显低于地佐辛组和舒芬太尼组[VAS评分术后6 h:(2.1 ±0.8)分比(3.0±0.8)、(2.5±0.6)分,术后12 h:(1.9±0.9)分比(2.8±0.8)、(2.4±0.7)分,术后24 h:(1.9±0.7)分比(2.6±0.9)、(2.2±0.8)分;Ramsay镇静评分术后6 h:(2.2±0.9)分比(3.2±0.9)、(2.5±0.9)分,术后12 h:(2.2±0.7)分比(3.0±0.8)、(2.4±0.9)分,术后24 h:(2.0±0.8)分比(2.7±0.9)、(2.3±0.8)分],差异有统计学意义(P＜0.05).术后48 h,3组Ramsay镇静评分比较,差异无统计学意义(P＞0.05).地佐辛组发生不良反应8例,其中恶心呕吐1例,头晕3例,嗜睡3例,皮肤瘙痒1例,舒芬太尼组发生不良反应10例,其中恶心呕吐3例,头晕2例,嗜睡2例,皮肤瘙痒2例,呼吸抑制1例,联合用药组发生不良反应2例,其中恶心呕吐1例,头晕1例.联合用药组术后48 h内PCIA有效按压次数低于地佐辛组和舒芬太尼组[(3.0±1.7)次比(4.8±1.8)、(4.2±1.2)次],差异有统计学意义(P＜0.05).联合用药组患者术后12、24、48 h血清5-羟色胺和P物质浓度明显低于地佐辛组和舒芬太尼组[5-羟色胺术后12 h:(371±68) nmol/L比(484 ±72)、(465±77) nmol/L,术后24 h:(398±62) nmol/L比(518±70)、(498±68) nmol/L,术后48 h:(366±67) nmol/L比(437 ±72)、(426±72) nmol/L;P物质术后12 h:(56±23) ng/L比(74±31)、(68±25) ng/L,术后24 h:(59±27) ng/L比(76±28)、(73±25) ng/L,术后48 h:(53±22) ng/L比(69±18)、(67 ±25) ng/L],差异有统计学意义(P＜0.05).结论 地佐辛联合舒芬太尼用于腹腔镜手术患者PCIA,能提供良好的术后镇痛效果,抑制术后5-羟色胺和P物质浓度的升高,且不良反应少.
目的 觀察地佐辛聯閤舒芬太尼用于腹腔鏡手術患者術後靜脈自控鎮痛(PCIA)的效果及對血清5-羥色胺和P物質的影響.方法 將2014年510月于湖北省黃石市第二醫院擇期行腹腔鏡手術患者60例完全隨機分為地佐辛組(20例)、舒芬太尼組(20例)和聯閤用藥組(20例).地佐辛組使用地佐辛0.6 mg/kg,舒芬太尼組使用舒芬太尼2μg/kg,聯閤用藥組使用地佐辛0.3 mg/kg±舒芬太尼1μg/kg,各組泵中均加入託烷司瓊5 mg及0.9％氯化鈉註射液配製至100 ml.記錄3組術後6、12、24、48 h的疼痛視覺模擬量錶(VAS)評分、Ramsay鎮靜評分,48 h內患者PCIA有效按壓次數及不良反應.檢測痳醉前及術後12、24、48 h血清5-羥色胺和P物質濃度.結果 聯閤用藥組患者術後6、12、24 h VAS評分、Ramsay鎮靜評分明顯低于地佐辛組和舒芬太尼組[VAS評分術後6 h:(2.1 ±0.8)分比(3.0±0.8)、(2.5±0.6)分,術後12 h:(1.9±0.9)分比(2.8±0.8)、(2.4±0.7)分,術後24 h:(1.9±0.7)分比(2.6±0.9)、(2.2±0.8)分;Ramsay鎮靜評分術後6 h:(2.2±0.9)分比(3.2±0.9)、(2.5±0.9)分,術後12 h:(2.2±0.7)分比(3.0±0.8)、(2.4±0.9)分,術後24 h:(2.0±0.8)分比(2.7±0.9)、(2.3±0.8)分],差異有統計學意義(P＜0.05).術後48 h,3組Ramsay鎮靜評分比較,差異無統計學意義(P＞0.05).地佐辛組髮生不良反應8例,其中噁心嘔吐1例,頭暈3例,嗜睡3例,皮膚瘙癢1例,舒芬太尼組髮生不良反應10例,其中噁心嘔吐3例,頭暈2例,嗜睡2例,皮膚瘙癢2例,呼吸抑製1例,聯閤用藥組髮生不良反應2例,其中噁心嘔吐1例,頭暈1例.聯閤用藥組術後48 h內PCIA有效按壓次數低于地佐辛組和舒芬太尼組[(3.0±1.7)次比(4.8±1.8)、(4.2±1.2)次],差異有統計學意義(P＜0.05).聯閤用藥組患者術後12、24、48 h血清5-羥色胺和P物質濃度明顯低于地佐辛組和舒芬太尼組[5-羥色胺術後12 h:(371±68) nmol/L比(484 ±72)、(465±77) nmol/L,術後24 h:(398±62) nmol/L比(518±70)、(498±68) nmol/L,術後48 h:(366±67) nmol/L比(437 ±72)、(426±72) nmol/L;P物質術後12 h:(56±23) ng/L比(74±31)、(68±25) ng/L,術後24 h:(59±27) ng/L比(76±28)、(73±25) ng/L,術後48 h:(53±22) ng/L比(69±18)、(67 ±25) ng/L],差異有統計學意義(P＜0.05).結論 地佐辛聯閤舒芬太尼用于腹腔鏡手術患者PCIA,能提供良好的術後鎮痛效果,抑製術後5-羥色胺和P物質濃度的升高,且不良反應少.
목적 관찰지좌신연합서분태니용우복강경수술환자술후정맥자공진통(PCIA)적효과급대혈청5-간색알화P물질적영향.방법 장2014년510월우호북성황석시제이의원택기행복강경수술환자60례완전수궤분위지좌신조(20례)、서분태니조(20례)화연합용약조(20례).지좌신조사용지좌신0.6 mg/kg,서분태니조사용서분태니2μg/kg,연합용약조사용지좌신0.3 mg/kg±서분태니1μg/kg,각조빙중균가입탁완사경5 mg급0.9％록화납주사액배제지100 ml.기록3조술후6、12、24、48 h적동통시각모의량표(VAS)평분、Ramsay진정평분,48 h내환자PCIA유효안압차수급불량반응.검측마취전급술후12、24、48 h혈청5-간색알화P물질농도.결과 연합용약조환자술후6、12、24 h VAS평분、Ramsay진정평분명현저우지좌신조화서분태니조[VAS평분술후6 h:(2.1 ±0.8)분비(3.0±0.8)、(2.5±0.6)분,술후12 h:(1.9±0.9)분비(2.8±0.8)、(2.4±0.7)분,술후24 h:(1.9±0.7)분비(2.6±0.9)、(2.2±0.8)분;Ramsay진정평분술후6 h:(2.2±0.9)분비(3.2±0.9)、(2.5±0.9)분,술후12 h:(2.2±0.7)분비(3.0±0.8)、(2.4±0.9)분,술후24 h:(2.0±0.8)분비(2.7±0.9)、(2.3±0.8)분],차이유통계학의의(P＜0.05).술후48 h,3조Ramsay진정평분비교,차이무통계학의의(P＞0.05).지좌신조발생불량반응8례,기중악심구토1례,두훈3례,기수3례,피부소양1례,서분태니조발생불량반응10례,기중악심구토3례,두훈2례,기수2례,피부소양2례,호흡억제1례,연합용약조발생불량반응2례,기중악심구토1례,두훈1례.연합용약조술후48 h내PCIA유효안압차수저우지좌신조화서분태니조[(3.0±1.7)차비(4.8±1.8)、(4.2±1.2)차],차이유통계학의의(P＜0.05).연합용약조환자술후12、24、48 h혈청5-간색알화P물질농도명현저우지좌신조화서분태니조[5-간색알술후12 h:(371±68) nmol/L비(484 ±72)、(465±77) nmol/L,술후24 h:(398±62) nmol/L비(518±70)、(498±68) nmol/L,술후48 h:(366±67) nmol/L비(437 ±72)、(426±72) nmol/L;P물질술후12 h:(56±23) ng/L비(74±31)、(68±25) ng/L,술후24 h:(59±27) ng/L비(76±28)、(73±25) ng/L,술후48 h:(53±22) ng/L비(69±18)、(67 ±25) ng/L],차이유통계학의의(P＜0.05).결론 지좌신연합서분태니용우복강경수술환자PCIA,능제공량호적술후진통효과,억제술후5-간색알화P물질농도적승고,차불량반응소.
Objective To observe the effect of dezocine combined with sufentanyl on analgesia and the changes of serum 5-hydroxytryptamine (5-HT) and P substance (PS) in patient-controlled intravenous analgesia (PCIA) after laparoscopic surgery.Methods Sixty patients with selective laparoscopic surgery were randomly divided into dezocine group (dezocine 0.6 mg/kg), sufentanil group (sufentanil 2 μg/kg) and combination group (dezocine 0.3 mg/kg ± sufentanil 1 μg/kg) ,with 20 cases in each group.Tropisetron (5 mg) and corresponding drugs were added into 0.9％ sodium chloride (total volume: 100 ml).The visual analog scale (VAS), Ramsay sedation score 6, 12, 24, and 48 h after operation were recorded;levels of 5-HT and PS before anesthesia and 6, 12, 24, and 48 h after operation were measured, effective numbers of PCIA pressing within 48 h and adverse effects were observed.Results Compared with those in dezocine group and sufentanil group, the VAS score and Ramsay sedation score in combination group were significantly decreased 6 h [(2.1 ± 0.8) scores vs (3.0 ± 0.8), (2.5±0.6) scores, (2.2±0.9) scores vs (3.2 ±0.9), (2.5 ±0.9) scores], 12 h [(1.9 ±0.9) scores vs (2.8 ± 0.8), (2.4 ± 0.7) scores, (2.2 ± 0.7) scores vs (3.0 ± 0.8) , (2.4 ± 0.9) scores], 24 h [(1.9±0.7) scoresvs (2.6±0.9), (2.2±0.8) scores, (2.0±0.8) scores vs (2.7±0.9), (2.3± 0.8) scores] after operation (P ＜0.05);48 h after operation the VAS score and Ramsay sedation score had no significantly differences among the three groups (P ＞ 0.05).The incidence of adverse effects in dezocine group was 40.0％ (8/20), including 1 case of nausea and vomiting, 3 cases of dizzy, 3 cases of drowsiness and 1 case of pruritus;the incidence of adverse effects in sufentanil group was 50.0％ (10/20), including 3 cases of nausea and vomiting, 2 cases of dizzy, 2 cases of drowsiness, 2 case of pruritus and 1 case of respiratory depression;the incidence of adverse effects in combination group was 10％ (2/20), including 1 case of nausea and vomiting and 1 case of dizzy.Compared with those in dezocine group and sufentanil group, serum 5-HT and PS concentrations in combination group were significantly decreased 12 h [(371 ± 68) nmol/L vs (484 ± 72), (465 ± 77) nmol/L, (56 ±23) ng/L vs (74 ±31), (68 ±25) ng/L], 24 h [(398 ±62) nmoL/L vs (518 ±70), (498 ±68) nmol/L, (59±27) ng/L vs (76 ±28), (73±25) ng/L] and 48h [(366 ±67) nmol/L vs (437 ±72), (426±72) nmol/L, (53 ± 22) ng/L vs (69 ± 18), (67 ± 25) ng/L] after operation (all P ＜ 0.05).Conclusion Dezocine combined with sufentanil can effectively relieve postoperative pain and inhibit the elevation of 5-HT and PS after laparoscopic surgery with less side effects.
