地佐辛复合芬太尼超前镇痛预防全麻苏醒期躁动的临床观察

摘要

Objective:To evaluate the effects of preemptive analge using Dezocine combined with fentanyl preventing agitation during recovery period of general anesthesia .Methods:100 patients ,ASAⅠ ~ Ⅱ ,scheduled for selective upper abdominal surgery ,were randomly divided into 4 groups ,25 patients in each group‐group dezocine (group A) ,group fentanyl (group B) ,group dezocine plus fentanyl (group C) and normal saline (group D) .At 10 minutes before skin in‐cision ,patients of group A ,B and C seperately received general anesthesia with infusion of dezocine 0 .2mg/kg ,fenta‐nyl 1μg/kg ,dezocine 0 .15mg/kg + fentanyl 0.6μg/kg .During operation ,patients received continious analge with 1/2 volume of the initiate dose every 30~40 minutes;patients of group D received equal volume of aline .All patients re‐ceived general anesthesia with continious infusion of remifentanil ,propofol and intermittent injection of Rocuronium bromide .BP and HR were recorded after suture of skin (T0 ) ,extubation (T1 ) ,5 minutes after extubation (T2 ) .The recovery time ,extubatino time ,Riker sedation‐agitation score before extubation and RSS agitation score 5 min after extubation were recorded too .Results:Compared with T0 ,BP ,HR at T1 and T2 in group A and group D were signifi‐cantly increased (P<0 .05) ,and BP ,HR in group B and group C were significantly lower than those in group D (P<0 .05);the recovery time and extubation time in group B are significantly longer than those in group A and group D ;the incident of Riker sedation‐agitation in group C is significantly lower than those in group D (P<0 .05) .Conclusion:Pre‐emptive analge using Dezocine combined with fentanyl can effectively prevent agitation during recovery period ,without the disadvantage of prolonging the recovery and extubation time .%目的：观察地佐辛复合芬太尼超前镇痛对全麻患者苏醒期躁动的预防作用。方法：选取行全身麻醉上腹部手术患者100例，A S AⅠ～Ⅱ级，随机分为地佐辛组（A组）、芬太尼组（B组）、地佐辛复合芬太尼组（C组）和对照组（D组），每组25例。A、B、C三组切皮前10min分别给予静脉注射地佐辛0．2mg／kg、芬太尼1μg／kg、地佐辛0．15mg／kg＋芬太尼0．6μg／kg。围术期以首次剂量1／2，间隔30～40min静脉注射持续镇痛；D组静注等量生理盐水。麻醉维持采用持续输注丙泊酚、瑞芬太尼，间断静脉注射罗库溴胺。记录四组患者手术缝皮后（T0）、拔管时（T1）、拔管后5min （T2），血压（BP）、心率（HR）的变化；记录睁眼时间、拔管时间；拔管前Riker镇静躁动评分、RSS躁动评分。结果：A组、D组T1、T2时的BP、HR明显高于T0时（P＜0．05），B组、C组同时间点BP、HR明显低于D组（P＜0．05）；B组睁眼时间、拔管时间明显长于A组、D组；C组Riker镇静躁动评分患者躁动发生率明显低于D组（ P＜0．05）。结论：地佐辛＋芬太尼联合超前镇痛能预防全麻患者苏醒期躁动，不会延长患者的睁眼时间和拔管时间。