地佐辛联合帕瑞昔布钠用于垂直斜视矫正术局部麻醉的镇痛效果研究

摘要

目的 研究地佐辛联合帕瑞昔布钠经静脉注射在垂直斜视的斜视矫正术中局部麻醉的镇痛效果.方法 选取山东省眼科研究所择期行斜视矫正术的垂直斜视患者80例,完全随机分为4组,每组20例,分别于术前15 min经静脉注射注射用帕瑞昔布钠40 mg(P组)、注射用地佐辛5 mg(D组)、注射用帕瑞昔布钠20 mg+注射用地佐辛2.5 mg(PD组)、注射用等剂量0.9％氯化钠注射液(N组).观察患者在术中5 min(T1)、术中15 min(T2)、术毕前5 min(T3)、术后2 h(T4)的疼痛数字模拟评分(NRS)、眼心反射及恶心呕吐、出汗等不良反应.因行上斜肌及下直肌手术的例数较少,故未对其在不同用药组间的NRS及眼心反射发生情况行统计学分析.结果 T1时点P、D、PD组NRS均较N组低,差异有统计学意义[(2.3±0.9)、(2.4±0.8)、(0.8±0.7)分比(5.2±0.7)分](P＜0.05);PD组NRS较P、D组低,差异有统计学意义(P＜0.05);P、D组间差异无统计学意义(P＞0.05).P组和D组患者各有1例呕吐,PD组患者无呕吐,N组患者发生呕吐3例(15.0％),但组间差异无统计学意义(P＞0.05).T2时点P、D、PD组NRS均较N组低[(3.2±1.1)、(2.4±0.7)、(1.5±0.8)分比(6.9±1.0)分],PD组NRS较P、D组低,D组NRS较P组低,差异均有统计学意义(均P＜0.05).4组间恶心呕吐症状,N组较P、D、PD组明显,差异有统计学意义(P＜0.05);P、D组较PD组明显,差异均有统计学意义(均P＜0.05);P、D组差异无统计学意义(P＞0.05).T3时点P、D、PD组NRS均较N组低,差异有统计学意义[(0.9±0.5)、(0.7±0.4)、(0.3±0.4)分比(1.9±0.9)分](P＜0.05);P、D、PD组间差异无统计学意义(P＞0.05).4组间恶心呕吐症状,N组较P、D、PD 3组明显,差异有统计学意义(P＜0.05);P、D、PD组间差异无统计学意义(P＞0.05).T4时点4组间NRS差异无统计学意义(P＞0.05).4组间恶心呕吐症状,N组较P、D、PD组明显,但各组各项观察指标差异均无统计学意义(均P＞0.05).上直肌与下斜肌眼心反射阳性率差异无统计学意义(P＞0.05).上直肌或下斜肌手术时眼心反射发生率及程度与NRS基本相同(P＞0.05).结论 成人局部麻醉下垂直斜视矫正术采用地佐辛联合帕瑞昔布钠超前镇痛,具有良好的术中和术后镇痛效果,并能明显减轻术后恶心呕吐症状.%Objective To study the analgesic effect of intravenous dezocine combined with parecoxib sodium during vertical deviation surgery under local anesthesia,and to explore an effective and safe analgesia method.Methods This was a prospective and randomized study.80 vertical deviation patients electively undergoing strabismus surgery under local anesthesia in thie hospital were randomly allocated to 4 groups (20 cases in each group):group P received intravenous parecoxib sodium (40 mg) ; group D received intravenous dezocine (5 mg) ; group PD received intravenous parecoxib sodium (20 mg) + intravenous dezocine (2.5 mg) ; group N received intravenous isodose normal saline.All patients received the drug at 15 min before surgery.The indexes including numeric rating scales(NRS),culocardiacreflex (OCR),and adverse reactions such as nausea,vomiting and sweating were observed and separately recorded at 5 min in operation(T1),15 min in operation(T2),5 min before the end of operation(T3),and 2 h after operation (T4).Results The NRS scores at T1 were significantly lower in groups P,D than in group N [(2.3 ± 0.9),(2.4 ± 0.8),(0.8 ± 0.7) scores vs (5.2 ± 0.7) scores] (P ＜ 0.05) and group PD (P ＜ 0.05).Nausea,vomiting and sweating at T1 were not significantly different among the 4 groups.The NRS scores at T2 were significantly lower in group PD than in group D (P ＜ 0.05).The nausea and vomiting were significantly higher in group N than in group PD (P ＜ 0.05) and group PD than in group P and D [(3.2±1.1),(2.4±0.7),(1.5±0.8)scores vs (6.9±1.0)scores](P＜0.05),but they were not significantly different between group P and D.The NRS scores in groups N at T3 were significantly higher than in groups P,DandPD [(0.9±0.5),(0.7±0.4),(0.3±0.4)scores vs (1.9±0.9)scores](P＜0.05).Nausea and vomiting were significantly higher in group N than in groups P,D and PD(P ＜ 0.05).At T4,nausea and vomiting were higher in group N than in groups P,D and PD,but they were not significantly different.The NRS scores were not significantly different among the 4 groups.Superior rectus muscle was not different from inferior oblique muscle.The OCR and NRS scores between superior rectus muscle and inferior oblique muscle were basically the same.Conclusion Preemptive analgesia with dezocine combined with parecoxib sodium for vertical deviation surgery under local anesthesia is effective and can reduce the postoperative nausea and vomiting.