地佐辛预先镇痛对腹式子宫全切除术后自控镇痛效果的影响

目的 观察地佐辛预先镇痛对腹式子宫全切除术后患者硬膜外自控镇痛（PCA）效果的影响.方法 腹式子宫全切除术患者90例,随机分为3组.I组于切皮前静脉推注地佐辛;II组于手术关腹时静脉推注地佐辛;III组于切皮前静脉推注生理盐水.三组患者术后均行PCA,镇痛液为0.2%左旋布比卡因与0.075%舒芬太尼共100ml,观察术后疼痛视觉模拟评分（VAS）;Ramesay分级,改良Bromayt分级与不良反应.结果 三组患者PCA期间,左旋布比卡因和舒芬太尼的用量I组明显低于II、IlI组（P〈0.05）,I组术后4、8 h的VAS评分明显低于II、III组（P〈0.05）.术后24 h内按压次数II、III组明显多于I/组（P〈0.05）,I、II组恶心、呕吐,皮肤瘙痒发生率略低于III组,但差异无统计学意义.结论 在手术切皮前静脉推注地佐辛预先镇痛可有效地增强腹式子宫全切除术后患者硬膜外PCA的术后镇痛效果.减少镇痛药量,延长镇痛时间,不良反应较少.

Effect of preemptive dezocine analgesia on the patient controlled epidural analgesia after transabdominal total hysterectomy

Objective To observe the effect of preemptive analgesia with dezocine on patient controlled epidural analgesia （PCA） after transabdominal total hysterectomy. Methods Ninety patients with transabdominal total hysterectomy were randomly divided into 3 groups. In group I the patients were intravenously injected dezocine before skin incision,in group II the patients were injec- ted dezocine before abdomen close, and in group III normal saline was injected before skin incision. All of the patients were received PCA with analgesic mixture contained 0.20//oo levobupivacaine and 0. 075~ suientanil in total o{ 100 ml. Visual analogue scale （VAS）, ramesay level, improved Bro- mayt grading and adverse reactions were observed in all patients after the operation. Results During PCA, the dosage of levobupivacaine and sufentanil in group I was significantly lower than that in group II, III （P〈0.05）, VAS at 4,8 h after the operation in group I was significantly lower than that in group II, III （P~0.05）. Within 24 h after the operation, the pressing time during PCA in group II, III was significantly more than that in group I （P〈0.05）. The incidences of nausea, vomi- ting and pruritus were slightly lower in group I, II than that in group III, but the difference was not statistically significant. Conclusion Preemptive analgesia with dezocine intravenously injected before surgical incision can effectively enhance the effect of epidural PCA, reduce the analgesic dosage, extend analgesia duration and lessen the adverse reaction after transabdominal total hysterectomy.