地佐辛超前镇痛对妇科腹腔镜手术后疼痛的影响

目的 探讨术前静注不同剂量地佐辛对妇科腹腔镜手术后疼痛的影响.方法 120例全身麻醉下行妇科腹腔镜手术患者,ASA Ⅰ～Ⅱ级,按数字表法随机分为A、B、C三组,每组40例.A组手术切皮前静注生理盐水5 ml,B组切皮前静注地佐辛0.1 mg/kg（稀释成5 ml）,C组切皮前静注地佐辛0.2 mg/kg（稀释成5 ml）.麻醉诱导诱导用药为咪唑安定、丙泊酚、顺阿曲库胺、芬太尼.麻醉维持泵注丙泊酚、瑞芬太尼,吸入七氟烷,间断注入顺阿曲库胺.分别于出复苏室后2h（T1）、4 h（T2）、8 h（T3）、24 h（T4）对患者行VAS、BCS评分,当患者VAS为8～ 10,BCS为0,给予曲马多100 mg im.记录各组曲马多使用时间、例数、次数.观察术后24 h内各组恶心呕吐、头昏嗜睡、呼吸抑制、皮肤瘙痒等不良反应.结果 C组各时点VAS评分低于A、B组,B组低于A组（P＜0.05）.A组术后曲马多使用量[（121.5±2.3）mg]大于B、C组（P＜0.05）,B组[（51.5±2.1）mg]大于C组[（18.7±1.8）mg] （P＜0.05）.术后各时点BCS评分C组最高,B组次之,A组最低（P＜0.05）.三组恶心呕吐的发生率比较无统计学差异（7.5％ vs.7.5％ vs.10％,P＞0.05）.B、C组躁动明显少于A组（2.5％ vs.2.5％ vs.10.0％,P＜0.05）.结论 地佐辛0.2 mg/kg超前镇痛可使妇科腹腔镜手术患者术后疼痛减轻,满意度提高.

Effect of preemptive analgesia with dezocine on postoperative pain in gynaecological laparoscopic surgery

Objective To study the effect of preemptive analgesia intravenous injection with different doses of dezocine on postoperative pain after gynecological laparoscopic operation.Methods 120 female adult patients （the ASA Ⅰ-Ⅱ） who underwent the gynecological laparoscopic surgery were randomly divided into three groups.Patients in the group A were given physiological saline 5 ml before operation.Patients in the group B were given dezocine 0.1 mg/kg （diluted to 5 ml） before operation.Patients in the group C were given dezocine 0.2 mg/kg （diluted to 5 ml） before operation.Anesthesia induction and anesthesia contiue were the same.After returning to the anesthesia recovery room,the pain of incision was assessed by VAS and BCS scores at 2 h（T1）,4 h（T2）,8 h（T3） and 24 h（T4）.When the VAS scores reached 8-10 and the BCS score was 0,patients were given 100 mg tramadol intramuscular injection.Records of the tramadol use time,number of cases,the intervals of tramadol.Results The VAS and BCS scores of patients at 2 h（T1）,4h（T2）,8 h（T3） and 24 h（T4） after reached the anesthesia recovery room,the experimental group was better than control group （P〈0.05）.Postoperative tramadol group A greater than group B （P〈0.05）,group B greater than group C （P〈0.05）.The incidence of adverse reactions of the three groups had no statistical difference （P〉0.05）.Conclusion Dezocine preemptive analgesia with 0.2 mg/kg can relieve pain in patients after gynecological laparoscopic operation,and increase satisfaction.