地佐辛复合地塞米松超前镇痛在儿童腺样体摘除术中的应用

目的探讨地佐辛复合地塞米松在儿童鼻内镜腺样体摘除术中超前镇痛的临床效果。方法将2011年1月至2012年6月收住入院待手术的60例腺样体肥大患儿随机分为A、B、C三组,每组20例,A组为超前镇痛组,术前静脉注射地佐辛0.1 mg/kg、地塞米松5 mg,术毕注射生理盐水2 mL;B组为术后镇痛组,术前静脉注射生理盐水2 mL,术毕注射地佐辛0.1 mg/kg、地塞米松5 mg;C组为对照组,术前、术后各静脉注射生理盐水2 mL。观察并记录三组诱导前、拔管时、拔管后5 min平均动脉压（MAP）、心率（HR）;苏醒拔管时间,苏醒期患儿有无躁动呛咳;术后0.5、1、2、4、6、12、24 h的视觉模拟评分（VAS评分）及各种不良反应的发生率。结果 C组患儿MAP、HR拔管时、拔管后均高于诱导前,且高于A、B组拔管时、拔管后,差异有统计学意义（P〈0.01）,C组患儿苏醒期躁动呛咳明显高于A、B组,差异有统计学意义（P〈0.01）,术后0.5、1、2、4、6、12、24 h的VAS评分及恶心、呕吐发生率均明显高于A、B组,差异有统计学意义（P〈0.05）,B组苏醒拔管时间大于A、C组,差异有统计学意义（P〈0.05）,A组术后4、6、12、24 h的VAS评分明显小于B组,差异有统计学意义（P〈0.05）。结论地佐辛、地塞米松复合液超前镇痛在儿童鼻内镜腺样体摘除术中具有协同作用,能延长术后镇痛的时间,降低恶心、呕吐发生率,且术后苏醒迅速、安全。

Application of dezocine combined with dexamethasone for preemptive analgesia in child adenoidectomy

Objective To investigate the clinical effect of dezocine combined with dexamethasone for preemptive analgesia in child nasal endoscopic adenoidectomy.Methods 60 children cases of adenoid hypertrophy undergoing adenoidectomy in this hospital from January 2011 to June 2012 were randomly divided into 3 groups,20 cases in each group.The group A as the preemptive analgesia group was given with dezocine 0.1 mg/kg plus dexamethasone 5 mg by intravenous injection before operation and saline 2 mL was injected after operation.The group B as the postoperative analgesia group was preoperatively given with saline 2 mL by intravenous injection and dezocine 0.1mg/kg plus dexamethasone 5 mg were intravenously injected after operation.The group C as the control group was given with saline 2 mL by intravenous injection preoperatively and postoperatively.The mean arterial pressure（MAP）,heart rate（HR）,awaking extubation time,dysphoria and bucking before induction,in extubation and at 5 min after extubation were observed and recorded in 3 groups.And the VAS scores at postoperative 0.5,1,2,4,6,12,24 h and the incidence rate of adverse reaction also were recored.Results MAP and HR in extubation and after extubation in the group C were higher than those before induction and the group A and B with statistical difference（P0.01）.Dysphoria and buckingin during awaking period in the group C were significantly higher than those in the group A and B with statistical difference（P0.01）.The VAS scores and the occurrence rate of nausea and vomiting at postoperative 0.5,1,2,4,6,12,24 h were obviously higher than those in the group A and B with statistical difference（P0.05）.The awaking extubation time in the group B was greater than that in the group A and C with statistical difference（P0.05）.The VAS scores at postoperative 4,6,12,24 h in the group A was significantly lower than that in the group B with statistical difference（P0.05）.Conclusion The compound solution of dezocine and dexamethasone for preemptive analgesia in child nasal endoscopic adenoidectomy has a synergistic effect,can prolong the postoperative analgesia time and reduce the occurrence rate of nausea and vomiting with rapid postoperative recovery and security.