喷他佐辛抑制老年患者腹部手术牵拉反应的临床观察

摘要] 目的 观察喷他佐辛抑制硬膜外麻醉下老年患者腹部手术牵拉反应的效果及安全性 。方法 75例60～75岁,ASAⅡ～Ⅲ级择期或急诊腹部手术患者随机分p0组：空白对照组；p1组：喷他佐辛组 ；p2组：喷他佐辛+咪唑安定组。3组患者硬膜外麻醉后切皮前p0组：不给镇静镇痛类药物；p1组：喷他佐辛0.4 mg/kg iv ；p2组：喷他佐辛0.3mg/kg+咪唑安定0.03 mg/kg iv。记录3组患者术中10、30、45min生命体征、镇静程度分级（Ramsay法），评定牵拉反应的抑制效果。结果p1、p2组患者术中10、30、45min MAP、HR、SpO2与麻醉后给药(喷他佐辛/咪唑安定)前基础值比较无显著性差异；术中10、30、45min p1、p2组镇静评分高于p0组（p<0.05），p2组术中30、45min镇静评分高于p1组（p<0.05）；p1、p2组患者术中牵拉反应轻微或几乎没有，p0组部分患者术中有明显的牵拉反应，明显多于p1和p2组（p<0.05）；p1、p2组之间相比较无差异(p>0.05)。结论 喷他佐辛能安全有效抑制老年患者腹部手术牵拉反应，复合使用咪唑安定效果更佳。

The clinical observation of pentazocine in restraining traction response during abdominal operation in elderly people undergoing epidural anesthesia

【Abstract】 Objective To observe the efficacy and security of pentazocine in reducing traction response during abdominal operation in elderly people undergoing epidural anesthesia. Methods Seventy-five ASAⅡ～Ⅲ patients,aged 60～75y, were randomly divided into p0 group(comparison group) ,p1 group (pentazocine group) and p2 group (pentazocine plus midazolam group).Pentazocine 0.4mg/kg (p1 group) or pentazocine 0.3mg/kg plus midazolam 0.03mk/kg(p2 group) was intravenously administered to patients at the moment for skin incision . The sedation score 、assessing traction response 、vital data (MAP、 HR and SPO2) were recorded and compared among groups .Results The ASA grade ,category of operation ,avergae age and weight had insignificant difference among groups. Vital data including MAP、HR and SPO2 had no statistically significant difference during operation in p1 and p2 groups . The patients in p1 and p2 groups had higher sedation score than those in p0 group (p<0.05) .The patients in p2 group had deeper sedation than those in p1 group (p<0.05) at the moment of 30 、45 min in operation .The patients in p1 and p2 groups had slightly or no traction response and they had no significant difference between p1 and p2 groups (p>0.05)whereas traction response was often occured in p0 group and there was distinct difference compared p0 group with p1 and p2 groups (p<0.05) . Conclusion Pentazocine can safely and effectively relieve the traction response during abdominal operation in elderly people undergoing epidural anesthesia and midazolam helps to enhance this efficiency.