地佐辛在开胸手术患者全身麻醉苏醒期的应用

目的观察地佐辛在开胸手术患者全身麻醉苏醒期应用的安全性和有效性。方法将90例美国麻醉医师协会Ⅰ-Ⅱ级开胸手术的患者按随机数字表随机分为对照组、舒芬太尼组和地佐辛组，各30例。各组患者均以依托咪酯＋舒芬太尼＋罗库溴铵诱导麻醉，术中以瑞芬太尼、异丙酚微量泵输注维持麻醉。手术结束前15min，对照组患者静脉注射0．9％氯化钠注射液2ml，舒芬太尼组患者静脉注射舒芬太尼，地佐辛组患者静脉注射地佐辛。术毕常规采用新斯的明和阿托品拮抗肌松，待呼吸恢复良好，拔除气管导管后送麻醉恢复室（PACU）观察。记录3组患者给药前（T0）、给药后5min（T1）、术毕时（T2）、拔管时（L）及拔管后5min（T4）的平均动脉压（MAP）、HR、脉搏血氧饱和度（SpO2）；记录患者拔管时间、定向力恢复时间、PACU驻留时间、拔管即刻及拔管后10、20、30min躁动评分、Ramsay镇静评分和拔管后恶心、呕吐及呼吸抑制的发生率。结果与对照组比较，在T1～T4时点，舒芬太尼组和地佐辛组患者的MAP及HR明显降低，差异有统计学意义（P〈0．05）；3组患者拔管时间、定向力恢复时间比较差异无统计学意义（P〉0．05），与对照组、舒芬太尼组比较，地佐辛组患者PACU驻留时间明显缩短，差异有统计学意义（56±11）min比（73±12）、（68±12）min，P〈0．05]；与舒芬太尼组相比，地佐辛组患者在拔管期各时点躁动评分明显降低0min：（1．87±0．32）分比（2．21±0．13）分；10min：（1．03±0．18）分比（2．07±0．09）分；20min：（0．89±0．10）分比（1．56±0．10）分；30min：（0．32±0．13）分比（0．45±0．07）分]，Ramsay镇静评分明显降低，差异有统计学意义0min：（2．34±0．57）分比（3．04±0．15）分；10min：（2．13士0．48）分比（2．89±0．16）分；20min：（2．01±0．13）分比（2．32±0．13）分；30min：（1．99±0．16）分比（2．07±0．12）分，P〈0．05]。结论开胸手术患者苏醒期应用地佐辛后血流动力学稳定、麻醉苏醒过程平稳，呼吸抑制发生率低。

Application of dezocine in patients undergoing thoracic surgery after general anesthesia

Objective To observe the safety and efficacy of dezocine in recovery period of general anesthesia for thoracic surgery. Methods Totally 90 patients undergoing thoracic surgery were divided into three groups： control group, sufentanil group and dezocine group. 15 min before the end of operation, 2 ml saline was given to patients of control group ; sufentanil 0.2 μg/kg was given in sufentanil group and dezocine 0. 1 mg/kg in dezocine group. Mean arterial pressure （MAP）, heart rate （HR）, pulse oxygen saturation （SpO2 ） were recorded. The persistence time of pulling out the endotracheal tube, disorientation recovery and observation in post anesthesia care unit （PACU） were also recorded. At the same time, the Agitation scale and Ramsay sedation score and the incidence of adverse reactions were recorded. Results Compared with control group, the MAP and HR of patients in sufentanil group and dezocine group had a significantly reduction at T1 to T4 （ P 〈 0.05 ）. Compared with control group and sufentanil group, the time of observation in PACU had a significantly reduction in dezocine group（P 〈0.05 ）. The Agitation scale of patients of dezocine group had a significant decrease at each recording time than that of sufentanil group ; meanwhile the Ramsay sedation score decreased significantly（P 〈 0.05）. Conclusion Application of dezocine in patients undergoing thoracic surgery in recovery period of general anesthesia can significantly improve the hemodynamic stability and decrease the incidence of respiratory depression.