地佐辛联合地塞米松超前镇痛应用.docVIP

地佐辛联合地塞米松超前镇痛应用 　　【摘要】 目的：观察静脉注射地佐辛联合地塞米松用于腹腔镜胆囊切除术超前镇痛的效果。方法：选择ASA Ⅰ～Ⅱ级择期腹腔镜胆囊切除术患者90例，随机分为三组，每组30例，Ⅰ组术前静脉注射地佐辛0.1 mg/kg+地塞米松10 mg，Ⅱ组术前静脉注射注射地佐辛0.1 mg/kg，Ⅲ组为对照组，未应用药物。观察患者术后2 h(T1)、6 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)的VAS、BCS评分、Ramsay镇静评分、镇痛药、止吐药追加情况及不良反应。结果：术后各个时间点，Ⅰ组的VAS低于Ⅱ组和Ⅲ组，BCS评分都高于Ⅱ组和Ⅲ组(P0.05)。Ⅲ组恶心、呕吐及咽喉不适发生率高于Ⅰ组和Ⅱ组(P 　　 【关键词】 地佐辛； 地塞米松； 超前镇痛； 协同作用； 腹腔镜胆囊切除术 　　 　　 The Application of Dezocine and Dexamethasone in Preemptive Analgesia/WEI Zheng-gui， LIU Hong， LI Yi-ting.//Medical Innovation of China，2012，9(9):9-10 　　 【Abstract】 Objective：To observe the preemptive analgesic effect of intravenous dezocine in combination with dexamethasone in laparoscopic cholecystectomy(LC). Methods： In this study， 90 patients graded as ASA Ⅰ～Ⅱ who were undergoing elective laparoscopic cholecystectomy were selected. They were randomly divided into three groups with 30 patients in each group. Group Ⅰ: dezocine 0.1/(mg?kg) and dexamethasone 10 mg intravenous injection was given preoperatively. Group Ⅱ: dezocine 0.1 mg/kg intravenous injection was given preoperatively. Group Ⅲ was control group. VAS and BCS score， Ramsay composure score， the superaddition and adverse effect of analgesics and antanacathartic were assessed in each individual group. Results： VAS score of Group Ⅰ was lower than that of Group Ⅱ and Ⅲ， and the BCS score of Group Ⅰ was higher than that of Group Ⅱ and Ⅲ(P0.05). The incidence of nausea， vomiting， and throat discomfort in Group Ⅲ was higher than that in Group Ⅰ(P0.05)，具有可比性。见表1。 　　 　　1.2 方法 所有患者术前肌注阿托品0.5 mg、鲁米那100 mg。入室后建立静脉通路，测量生命体征。麻醉诱导前静脉输入林格氏液8～10 ml/kg。所有患者均采用气管内插管静脉复合全麻、机制呼吸下(f=12， Vt 8～10 ml/kg， I:E=1:2)行腹腔镜胆囊切除术。麻醉诱导均为咪达唑仑0.06 mg/kg，芬太尼0.4 μg/kg、阿曲库安5 mg/kg、丙泊酚1～1.5 mg/kg静脉注射；麻醉维持用药为丙泊3～5 mg/(kg?h)静脉输注，间断静脉注射芬太尼0.05～0.1 mg、阿曲库铵12.5～20 mg。Ⅰ组手术切皮前15 min静注0.1 mg/kg地佐辛+10 mg地塞米松；Ⅱ组切皮前15 min静注0.1 mg/kg地佐辛；Ⅲ组不用任何药物。所有患者术中常规监测血压(BP)、心率(HR)、心电图(ECG)、血氧饱和度(SpO2)、呼末二氧化碳分压(PetCO2)，术毕前20 min停用阿曲库铵，术毕停用丙泊酚，患者清醒后拔除气管导管送回病房观察。所有患者术后均未行患者自控镇痛。