不同剂量地佐辛对胃癌手术患者全麻气管拔管反应及苏醒期躁动的影响

目的:探讨不同剂量地佐辛对胃癌手术全麻患者气管拔管反应及苏醒期躁动的影响。方法:80例ASAⅠ～Ⅱ级择期胃癌手术患者随机均分为4组，每组20例。分别于手术结束前20 min缓慢静脉注射地佐辛0.05 mg/kg（D1组）、0.1 mg/kg（D2组）、0.2 mg/kg（D3组）和0.9%氯化钠注射液2 ml（N组）。观察并记录诱导前（T₀）、拔除气管导管前吸痰时（T₁）、拔除气管导管时（T₂）、拔出气管导管后5 min（T₃）、拔出气管导管后10 min（T₄）的平均血压（MAP）、心率（HR）、呼吸频率、血氧饱和度。记录患者自主呼吸恢复时间、睁眼时间、拔除气管导管时间、拔管质量评分和术后躁动评分，采用语言描述评分法（VRS）评估拔管后5 min时的疼痛程度。结果:D1组T₁～T₃、D2组T₁ 和T₂、 D3组T₁及N组T₁ ～T₄时患者的MAP均较T₀升高（P<0.05～P< 0.01），D1组和N组T₁ ～T₄、 D2 组和 D3组T₁ ～T₃时患者的HR均较T₀明显加快（P<0.01）。D2组T₁ 和T₂、D3组T₁ ～T₄时患者的MAP均低于N组（P<0.05～P<0.01），D2组T₁ 和T₃、D3组T₁ ～T₄时患者的HR均低于N组（P<0.05～P<0.01）。D3组患者自主呼吸恢复时间、睁眼时间和拔除气管导管时间明显延长（P<0.01），D1组、 D2组和N组组间比较差异均无统计学意义（P>0.05）。D1组、D2组、D3组拔管质量评分均优于N组（P<0.01），且D2组优于D1组（P<0.01）；D2组躁动评分优于N组和D1组（P<0.01）；拔管后5min时的VRS评分:D1组、 D2组、D3组均优于N组（P<0.05~P<0.01），且D2组、D3组均优于D1组（P<0.05）。结论:不同剂量地佐辛可减轻全麻患者气管拔管反应，且0.1 mg/kg地佐辛能有效抑制苏醒期躁动，对呼吸及苏醒时间无明显影响。

Effects of different doses of dezocine on tracheal extubation reaction and postoperative agitation in patients undergoing gastric cancer surgery with general anesthesia

Objective：To explore the influence of different doses of dezocine on anesthesia tracheal extubation reaction and postoperative agitation of patients receiving gastric cancer surgery.Methods：Eighty ASA Ⅰ or Ⅱ patients undergoing elective gastric cancer surgery were randomly divided into four groups,with 20 cases in each one.The four groups were respectively given 0.05 mg/kg of intravenous dezocine（group D1）,0.1 mg/kg of intravenous dezocine （group D2）,0.2 mg/kg of intravenous dezocine （group D3） and 0.9％ sodium chloride injection 2 ml（group N） 20 minutes before the end of the surgery.The MAP,HR,RR and SpO2 were observed and recorded before the induction（T0）,the time of sputum suction before extubation（T1）,immediately after extubation（T2）,and 5 min （T3） and 10 min （T4） after extubation.The postoperative recovery time of spontaneous breathing and awakening,the extubation time,the tube drawing quality score and the postoperative agitation score （RS） were also recorded.The pain degree was assessed with verbal rating scale （VRS） 5 minutes after revival from general anesthesia.Results：Compared with T0,the MAP rose obviously at T1-T3 in group D1,at T1-T2 in group D2,at T1 in group D3 and at T1-T4 in group N （P ＜ 0.05 to P ＜ 0.01） ;the HR rose obviously at T1-T4 in group D1 and group N,at T1 and T3 in group D2 and group D3 （P ＜ 0.01） ; compared with group N,the MAP decreased obviously at T1-T2 in group D2 and at T1-T4 in group D3 （P ＜ 0.05 to P ＜ 0.01） ; HR slowed significantly at T1 and T3 in group D2,and at T1-T4 in group D3 （P ＜ 0.05 to P ＜ 0.01）.The recovery time of spontaneous breathing,awakening and the extubation time was obviously lengthened in group D3 （P ＜ 0.01） ;there were no statistically significant differences among group D1,D2 and group N （P ＜ 0.05）.The tube drawing quality score of group D1,D2 and D3 was superior to that of group N （P ＜ 0.01）,and group D2 was better than group D 1 （P ＜ 0.01） ;The p