地佐辛用于腹腔镜胆囊切除术后镇痛效果观察

目的 探讨地佐辛不同剂量不同给药时间用于腹腔镜胆囊切除术后镇痛有效性和安全性.方法 选择ASA Ⅰ～Ⅱ级择期腹腔镜胆囊切除术患者80例,随机单纯法均分成四组,每组均20例.Ⅰ组：麻醉后手术开始前静脉注射地佐辛0.10 mg/kg;Ⅱ组：麻醉后手术开始前静脉注射地佐辛0.15 mg/kg;Ⅲ组：术毕停麻醉药后10 min静脉注射地佐辛0.10 mg/kg;Ⅳ组：术毕停麻醉药后10 min静脉注射地佐辛0.15 rng/kg.比较四组术后1、6、12、24 h时间点的疼痛评分[采用视觉模拟评分法（VAS）]、舒适度评分（BCS）、麻醉后恢复评分（改良Aldrete评分）及不良反应.结果 四组术后lh的VAS：Ⅰ组与Ⅲ组比较差异有统计学意义（t =2.308,P=0.036）,Ⅰ组与Ⅳ组差异有统计学意义（t=2.106,P=0.042）,Ⅱ组与Ⅲ组比较差异有统计学意义（t =2.711,P=0.014）,Ⅱ组与Ⅳ组比较差异有统计学意义（t=2.317,P=0.037）;BCS：Ⅰ组与Ⅲ组比较差异有统计学意义（t=2.108,P=0.042）,Ⅰ组与Ⅳ组比较差异有统计学意义（t=2.069,P=0.048）,Ⅱ组与Ⅲ组比较差异有统计学意义（t=2.353,P=0.033）,Ⅱ组与Ⅳ组比较差异有统计学意义（t=2.361,P=0.036）;6 h的VAS：Ⅰ组与Ⅲ组比较差异有统计学意义（t=2.084,P=0.045）,Ⅱ组与Ⅲ组比较差异有统计学意义（t=2.309,P=0.038）,Ⅱ组与Ⅳ组比较差异有统计学意义（t=2.303,P=0.040）;BCS：Ⅰ组与Ⅲ组比较差异有统计学意义（=2.294,P=0.041）,Ⅱ组与Ⅲ组比较差异有统计学意义（t=2.322,P=0.035）,Ⅱ组与Ⅳ组比较差异有统计学意义（t=2.070,P=0.048）;12 h的BCS：Ⅱ组与Ⅲ组比较差异有统计学意义（t=2.518,P=0.047）;其他各时间点的VAS和BCS评分组间差异均无统计学意义（均P＞0.05）.结论 地佐辛0.10 mg/kg和0.15 mg/kg之间剂量可用于术后镇痛,0.15 mg/kg剂量麻醉后手术开始前给药,能有效缓解术后疼痛,提高术后舒适度,不良反应少,值得临床推广.

The analgesic effect of dezocine on patients after laparoscopic cholecystectomy

Objective To investigate the efficacy and safety of different doses of dezocine at different admin- istration time on analgesia after laparoscopic cholecystectomy. Methods 80 patients elected from ASA I - ]1 grade laparoscopic cholecystectomy were randomly divided into four groups, 20 cases in each group. Group I was anesthe- tized by intravenously injected dezoeine 0. 10mg/kg before the surgery, group ]I was anesthetized by dezocine 0. 15mg/kg before the surgery, group ]]I was anesthetized by intravenously injected dezocine 0.10mg/kg after stopping anesthetic surgery ,and group 1V was anesthetized by intravenously injected dezocine 0.15mg/kg after stopping anes- thetic surgery. The postoperative pain scores were observed 1,6,12,24 hours after operation in the four groups by using visual analog scale （ VAS ）, comfort score （ BCS ）, and anesthesia recovery score （ modified Aldrete score ）. Results TheVAS of the four groups 1 hour after surgery： group I and group m was significantly different （ t = 2. 308, P = 0. 036） , group I and group IV was significantly different（ t = 2. 106,P = 0. 042 ） , group II and group m was sig- nificantly different（ t =2. 711 ,P =0.014） ,group ]] and group IV was significantly different（t =2. 317 ,P =0.037）. The BCS 1 hour after surgery： group I and group ]1[ was significantly different（ t = 2. 108, P = 0. 042 ）, group I and group IV was significantly different（ t = 2. 069, P = 0. 048 ） , group ]] and group ]]I was significantly different （ t = 2. 353 ,P = 0. 033 ） , group ]I and group IV was significantly different（ t = 2. 361 ,P = 0.036）. The VAS 6 hours after surgery：group I and group 1][ was significantly different（t =2. 084,P =0. 045） ,group 11 and group m was signifi- cantly different （ t - 2. 309, P = 0.038 ）, group II and group IV was significantly different （ t = 2. 303, P = 0. 040 ）. The BCS 6 hours after surgery： group I and group 11[ was significantly different（ t = 2. 294, P = 0. 041 ）, group ]I and group m was significantly different（t = 2. 322,P = 0. 035） , group ]] and group 1V was significantly different（ t = 2. 070 ,P =0. 048）. The BCS 12 hours after surgery：group ]1 and group IlI was significantly different（t =2. 518 ,P = 0. 047）. VAS and BCS. scores at other time points had no significant difference （ P 〉 0.05 ）. Conclusion The analge- sic after laparoscopic gallbladder surgery using dezocine 0. 10n~g/kg-0. 15mg/kg, especially 0. 15mg/kg administered anesthesia before surgery , can effectively relieve postoperative pain and improve postoperative comfort , reduce postoperative analgesic（pain pump） and has less adverse reactions, which is worthy of promotion.