不同剂量地佐辛对全身麻醉下老年腹部手术患者的镇痛效果及对术后气管拔管应激反应的影响
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Analgesic effect of dezocine in different doses on elderly patients undergoing abdominal operation under general anesthesia and its influence on stress response to postoperative tracheal extubation
背景与目的
研究不同剂量地佐辛对全身麻醉下老年腹部手术患者的镇痛效果，及探讨地佐辛对术后气管拔管应激反应的影响。
方 法
选取2015年1月至2016年1月在我院接受全身麻醉下行腹部手术及术后镇痛的76例老年患者，选取芬太尼组为对照组（芬太尼10μg/ kg，n = 19） 。随机分为低剂量组（地佐辛0.05 mg / kg，n = 19），中剂量组（地佐辛0.1 mg / kg，n = 19）和高剂量组（地佐辛0.15 mg / kg，n = 19）。每组患者均静脉注射0.1mg / kg的托烷司琼。每组患者在拔出气管导管前及拔管后10 min，详细记录其心率（HR），呼吸频率（RR），平均动脉压（MAP），脉搏氧饱和度（SpO2），此外，观察并评估四组患者术后 4h, 8h, 12h, 24h 及 48 h的视觉模拟量表（VAS）评分、拉姆齐镇静评分、不良反应的发生率、舒适评分（BCS）及镇痛泵按压次数。
结 果
拔管前与拔管后10 min相比，低剂量组，中剂量组和高剂量组三组患者HR，RR，MAP及SPO2差异无统计学意义，但对照组拔管后HR，RR，MAP和SPO2显着增加（p <0.05）。48h内VAS评分低剂量组显着高于对照组，中剂量组和高剂量组（P <0.05）。低剂量组和中剂量组的Ramsay镇静评分明显低于对照组和高剂量组（P <0.05），低剂量组的BCS评分低于中剂量组，高剂量组和对照组（P <0.05）。此外，对照组和低剂量组的患者术后不良反应发生率均高于中剂量组和高剂量组（p <0.05），低剂量组患者的镇痛泵按压次数多于对照组、中剂量组及高剂量组，且低剂量、中剂量组及高剂量按压次数逐渐减少。最后，相关分析结果显示，地佐辛的剂量与Ramsay镇静评分呈正相关，但与患者的VAS评分呈负相关。
结 论
地佐辛能有效增强全身麻醉下老年腹部手术患者术后的镇痛效果且呈剂量依赖性。 此外，地佐辛还能显着降低老年患者术后气管拔管的应激反应，降低其全麻腹部手术后不良反应的发生率。
原始文献摘要
Z.-Y. YAO1, Z. JIA2, Y.-H. XIE1, L.-L. ZHANG1, H.-S. ZHANG1, W.-Q. WU1,C.-K. ZHANG1, L.-J. GAN3； Analgesic effect of dezocine in different doses on elderly patients undergoing abdominal operation under general anesthesia and its influence on stress response to postoperative tracheal extubationEur Rev Med Pharmacol Sci. 2017 Nov;21(22):5223-5229. doi: 10.26355/eurrev_201711_13845.
OBJECTIVE: To study the analgesic effect of dezocine in different doses on elderly patients undergoing abdominal operation
under general anesthesia and to investigate the influence of dezocine on stress response to postoperative tracheal extubation.
PATIENTS AND METHODS: A total of 76 elderly patients undergoing abdominal operation under general anesthesia and postoperative analgesia in our hospital from January 2015 to January 2016 were selected, and patients treated with fentanyl were selected as the control group (fentanyl: 10 μg/kg, n=19). The patients were randomly divided into low-dose group (dezocine:0.05 mg/kg, n=19), medium-dose group (dezocine: 0.1 mg/kg, n=19) and high-dose group (dezocine: 0.15 mg/kg, n=19). The patients in each group were intravenously injected with 0.1 mg/kg tropisetron. The tracheal catheter was withdrawn from patients in each group; the heart rate (HR), respiratory rate (RR), mean arterial pressure (MAP) and saturation of pulse oxygen (SpO2) of patients in each group before and at 10 min after tracheal extubation were recorded in detail; moreover, the visual analogue scale (VAS) score, Ramsay sedation score, occurrence rate of adverse reactions, Bruggrmann comfort scale (BCS) score and times of pressing analgesia pump after operation of patients in the four groups were evaluated at 4, 8, 12, 24 and 48 h after operation.
RESULTS: Compared with those before operation, there were no statistically significant differences in HR, RR, MAP and SPO2 of patients in low-dose group, medium-dose group and high-dose group at 10 min after tracheal extubation, and HR, RR, MAP and SPO2 of patients in control group were significantly increased after tracheal extubation (p<0.05). TheVAS scores of patients in low-dose group within 48 h were significantly higher than those in control group, medium-dose group and highdose group (p<0.05). The Ramsay sedation scores of patients in low-dose group and medium-dose group were significantly lower than
those in control group and high-dose group (p<0.05), and the BCS score of patients in low-dose group was lower than those in medium-dose group, high-dose group, and control group (p<0.05). Besides, the occurrence rates of postoperative adverse reactions of patients in control group and low-dose group were higher than those in medium-dose group and highdose group (p<0.05), the times of pressing analgesia pump after operation of patients in low-dose group were more than those in control group, medium-dose group and high-dose group (p<0.05), and the times were reduced successively in low-dose group, medium-dose group, and high-dose group. Finally, the results of correlation analysis showed that the dose of dezocine was positively correlated with the Ramsay sedation score, but negatively correlated
with the VAS score of patients.
CONCLUSIONS: Dezocine can effectively enhance the analgesic effect on elderly patients receiving abdominal operation under general anesthesia in a dose-dependent manner. Moreover, dezocine can significantly reduce the stress response of elderly patients to postoperative tracheal extubation, and reduce the occurrence rate of adverse complications after abdominal operation under general anesthesia.
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