地佐辛对神经外科患者术后静脉自控镇痛疗效观察及对内皮素-1水平的影响

目的观察地佐辛对神经外科手术患者术后静脉自控镇痛（PCIA）疗效和血浆内皮素-1（内皮素-1）水平的影响。方法择期行神经外科手术患者60例，随机均分为三组：D组（地佐辛行PCIA）、F组（芬太尼行PCIA）、C组（未行PCIA），记录术后1、2、4、12和24 h的疼痛视觉模拟评分（VAS）、Ramsay镇静评分及不良反应，分别于麻醉前、术后1、2、4、12和24 h抽取静脉血，应用放射免疫法检测血浆内皮素-1的水平。结果 D组和F组患者术后各时间点VAS评分均明显低于C组，差异均有统计学意义（t分别=2.24、2.33、2.57、2.88、3.56、2.39、2.52、2.97、3.62、4.86， P均＜0.05），D组和F组各时间点Ramsay镇静评分均明显高于C组，差异均有统计学意义（t分别=1.82、2.13、2.49、2.39、2.86、2.21、2.38、2.69、2.92、3.48， P均＜0.05）。 D组头晕嗜睡、恶心呕吐发生率均低于F组，差异均有统计学意义（χ2分别=2.77、3.91， P均＜0.05）；术后2、4、12和24 h，C组的血浆内皮素-1水平明显高于D组和F组，差异均有统计学意义（t分别=1.64、1.90、2.25、3.52、2.02、2.58、3.17、4.21， P均＜0.05），术后12 h和24 h，D组血浆内皮素-1水平明显低于F组，差异均有统计学意义（t分别=1.66、1.89， P均＜0.05）。结论术毕前静脉输注地佐辛能有效抑制术后应激造成的血浆内皮素-1水平增高，镇痛效果好且不良反应少，适合于神经外科术后镇痛。

Clinical effects of dezocine on patient-controlled intravenous analgesia and serum ET-1 level in neurosurgery patients

Objective To observe the effects of dezocine on patient-controlled intravenous analgesia and serum ET-1 level in neurosurgery patients. Methods Sixty patients who underwent neurosurgery surgery were randomly assigned into three groups：group D（PCIA with dezocine）, group F（PCIA with fentanyl） and group C（did not do PCIA）. The VAS scores and Ramsay sedation score at 1 hour, 2 hours, 4 hours, 12 hours and 24 hours after operation were assessed and adverse reaction were recorded. The serum ET-1 level was detected by radioimmunoassay. Results VAS scores of group D and group F at 1 hour, 2 hours, 4 hours, 12 hours and 24 hours after operation were significantly lower than those of groups C （t=2.24, 2.33, 2.57, 2.88, 3.56, 2.39, 2.52, 2.97, 3.62, 4.86, P〈0.05）. Ramsay sedation score of group D and group F at 1 hour, 2 hours, 4 hours, 12 hours and 24 hours after operation were significantly higher than those of groups C（t=1.82, 2.13, 2.49, 2.39, 2.86, 2.21, 2.38, 2.69, 2.92, 3.48, P〈0.05）. The incidence of dizziness and drowsiness, nausea and vomiting of group D were significantly lower than those of group F （χ2=2.77, 3.91, P〈0.05）. The serum ET-1 level of groups C at 2 hours, 4 hours, 12 hours and 24 hours after operation were significantly higher than those of group D and group F （t=1.64, 1.90, 2.25, 3.52, 2.02, 2.58, 3.17, 4.21, P〈0.05）. The serum ET-1 level of groups D at 12 hours and 24 hours after operation were significantly lower than that of group F（t=1.66, 1.89, P〈0.05）. Conclusion Intravenous in-fusion of dezocine before surgery completed can effectively inhibited the ET-1 levels increasing which was induced by postop-erative stress and it has good analgesia effect and few adverse reactions. It is suitable for neurosurgical postoperative analgesia.