地佐辛超前镇痛对瑞芬太尼致甲状腺术后痛觉过敏的影响

目的观察地佐辛超前镇痛对瑞芬太尼致甲状腺术后痛觉过敏的影响。方法拟行甲状腺次全切术患者60例,随机分成D组、M组和C组(n=20)。全麻诱导后气管插管,术中输注异丙酚、瑞芬太尼和顺式阿曲库铵维持麻醉。记录苏醒时间、意识恢复时间和拔管时间;观察拔管期间躁动和寒颤的发生情况,以及意识恢复后5min时的VRS评分。采用VAS评分于术后1 h(T1)、2 h(T2)、4 h(T3)、8 h(T4)、12 h(T5)和24 h(T6)等时点评价患者静态和动态的疼痛程度。记录术后24 h内呼吸抑制、恶心呕吐、嗜睡、恶心呕吐和皮肤瘙痒的发生情况。结果 M组苏醒时间、意识恢复时间、拔管时间均长于D组和C组(p<0.05);C组意识恢复后5 min时VRS评分明显高于其他两组(p<0.05);与C组比较,D组和M组T1-6时静态和动态VAS评分均明显降低(p<0.05);与M组比较,D组与M组各时点差异无统计学意义(p>0.05);拔管期间躁动发生率C组明显高于D组和M组(p<0.05);恶心呕吐、嗜睡、皮肤瘙痒发生率M组明显高于C组和D组(p<0.05)。结论地佐辛超前镇痛可有效预防瑞芬太尼致甲状腺术后痛觉过敏,与吗啡相比,恢复更快,副作用更少。

EFFECT OF DEZOCINE ON REMIFENTANIL-INDUCED POSTOPERATIVE HYPERALGESIA IN PATIENTS UNDERGOING SUBTOTAL THYROIDECTOMY

Objective To investigate the effects of dezocine on remifentanil -induced postoperative hyperalgesia in patients undergoing subtotal thyroidectomy. Methods sixty ASA 1 ~ 2 patients, undergoing subtotal thyroidectomy,were randomly divided into 3 groups （n = 20 each）. The patients were mechanically ventilated after tracheal intubation. Anesthesia was maintained with infusion of propofol, remifentanil and cisatracuronium. The emergence time, consciousness recovery time, extubation time, incidence of agitation and shivering, and VRS score at 5min after recovery were recorded. Pain at rest and movement was evaluated by using VAS score at 1,2, 4, 8, 12 and 24h （T1 - 6） after surgery were recorded. Results The emergence time, consciousness recovery time and extubation time were significantly longer in Group M than in Group D and C（p 〈0.05） ; The VRS score in Group C were significantly higher than Group D and M（p 〈 0.05 ） ; Compared with Group C, VAS scores at rest and movement were significantly decreased in both Group D and M（p 〈0. 05）, while there was no significantly difference between Group D and M（p 〉0. 05） ; The incidence of agitation in Group C was significantly larger than Group D and M（p 〈0. 05） ; the incidence of nausea and vomiting, lethargy and pruritus were significantly larger in Group M than the other two groups （p 〈 0. 05 ）. Conclusion Preemptive analgesia with dizocine can reduce remifentanil - induced postoperative hyperalgesia in patients undergoing subtotal thyroidectomy, Compared with morphine, it has the superiority of less side effects and more rapidly recovery time.