摘要
目的观察静脉注射地佐辛联合罗哌卡因术毕切口浸润在腹腔镜卵巢囊肿切除术后镇痛中的效果。方法选取内蒙古医科大学附属医院2014年9月至2015年3月全身麻醉下行腹腔镜卵巢囊肿切除手术的患者60例，完全随机分为空白对照组、地佐辛组、地佐辛联合罗哌卡因组，各20例。空白对照组不做任何处理，地佐辛组患者于术毕前30min静脉注射地佐辛0．1mg／kg，地佐辛联合罗哌卡因组患者于术毕前30min静脉注射地佐辛0．1mg／kg，在关气腹后以0．5％罗哌卡因在皮下组织与壁层腹膜内逐次浸润，每个切口2～3ml。3组麻醉诱导、维持方法相同，术中根据脑电双频指数调整静脉麻醉深度，在麻醉清醒后的0、2、4、6、12、24h记录疼痛视觉模拟量表（VAS）评分，若〉4分则给予哌替啶1rag／kg肌内注射，并记录使用镇痛剂的例数及术后不良反应发生情况，术中持续监测无创血压、心电图、呼吸、脉搏、血氧饱和度。结果地佐辛联合罗哌卡因组术后4、6、12h镇痛效果优于空白对照组及地佐辛组，差异有统计学意义[4h：（1．7±0．9）分比（3．5±0．8）、（3．1±0．5）分，6h：（1．8±0．7）分比（3．6±1．0）、（2．0±0．8）分，12h：（1．6±0．8）分比（3．0±1．0）、（2．9±2.0．8）分，P〈0．05或P〈0．01]。地佐辛组术后4、6h镇痛效果优于空白对照组，差异有统计学意义（P〈0．05）。地佐辛联合罗哌卡因组额外镇痛药使用率低于空白对照组与地佐辛组[10．0％（2／20）比65．0％（13／20）、30．0％（6／20），P〈0．05]。3组均无呼吸抑制情况发生，恶心、呕吐发生率差异均无统计学意义（均P〉0．05）。3组术后平均动脉压、心率比较差异无统计学意义（P〉0．05）。结论静脉注射地佐辛联合罗哌卡因术毕切口浸润在腹腔镜卵巢囊肿切除术后镇痛效果明确、不良反应少、安全可行。
Objective To investigate the analgesic effect of intravenous injection of dezocine combined with incision infiltration of ropivacaine after laparoseopic ovarian cyst resection. Methods Sixty patients who underwent laparoscopic ovarian cyst resection under general anesthesia from September 2014 to March 2015 were randomly divided into control group, dezocine group and dezocine combined with ropivacaine group, owning 20 cases in each group. No analgesics was administered after operation in control group; 0. 1 mg/kg dezocine was given intravenously 30 rain before the end of the surgery in dezocine group ; 0. 1 mg/kg dezocine was given intravenously 30 rain before the end of operation, then incision infiltration of 0. 5% rovivaeaine was performed （2-3 ml per cision） after closing pneumoperitoneum in dezocine combined with ropivacaine group. The methods of anesthesia induction and maintenance were the same among groups, the intravenous anesthetic depth was adjusted according to bispectral index. The visual analog scale （VAS） score was assessed 0, 2, 4, 6, 12 and 24 h after anesthesia awareness ; if VAS score 〉 4, intramuscular injection of 1 mg/kg pethidine was administrated. The cases using additional anagesie drugs and postoperative adverse reactions were recorded. Non-invasive blood pressure, electro- cardiogram, respiration, pulse and oxygen saturation were continuously monitored after operation. Results The postoperative analgesic effect in dezoeine group was significantly better than that in control group 4, 6 hours after awareness, （ P 〈 0. 05 ） , in dezoeine combined with ropivacaine group was significantly better than that in control group and dezoeine group 4, 6, 12 h after awareness [ （1.7 ±0. 9） scores vs （3.5±0. 8）, （3. 1 ±0. 5） scores; （1.8±0.7） scoresvs （3.6±1.0）, （2.0 ±0.8） scores;（1.6±0.8） scores vs （3.0±1.0）, （2.9 ±0.8） scores] （P 〈0. 05 or P 〈0. 01 ）. The use rate of additional anagesic drugs in dezocine combined with ropivaeaine group was significantly lower than that in control group and dezocine group [ 10. 0% （2/20） vs 65.0% （ 13/20）,30. 0% （6/20） ] （P 〈 0. 05 ）. There were no significant differences regarding incidences of postoperative adverse reactions, such as nausea, vomiting and respiratory depression among three groups （ P 〉 0. 05 ）. The postoperative mean arterial pressure and heart rate showed no significantly differences among the three groups （ P 〉 0. 05 ）. Conclusion Intravenous injection of dezocine combined with infiltration of ropivacaine can significantly reduce the postoperative pain after laparoscopic ovarian cystectomy, with more stable analgesic efficacy and safety.
出处
《中国医药》
2015年第12期1832-1835,共4页
China Medicine
基金
内蒙古自治区自然科学基金（2013MS1139）
