地佐辛与瑞芬太尼对经腹直肠癌根治手术麻醉镇痛效果的比较

发布时间：2018-05-10 06:45

本文选题：地佐辛 + 瑞芬太尼　；参考：《广东医学》2015年21期

【摘要】：目的对比地佐辛与瑞芬太尼用于经腹直肠癌根治手术中麻醉镇痛的效果。方法择期行腹腔镜下直肠癌根治术的患者100例,ASAⅡ~Ⅲ级,年龄65~75岁,体重45~65 kg,随机分为地佐辛组和瑞芬太尼组。地佐辛组静脉恒速输注地佐辛1~3μg/(kg·min);瑞芬太尼组静脉恒速输注瑞芬太尼0.1~0.3μg/(kg·min)进行麻醉镇痛。术中地佐辛或瑞芬太尼输注速度根据血压、心率情况调节。记录麻醉前、切皮、建立气腹、分离组织、术毕、拔管及拔管后10 min患者平均动脉压(MAP)、心率(HR)、Narcotrend麻醉深度指数以及患者苏醒时间、拔除气管导管时间及离开PACU时间;进行苏醒后即刻及1 h、2 h时视觉模拟评分(VAS)、布氏舒适评分(BCS)和镇静/躁动评分(SAS);记录术后48 h内呼吸抑制、恶心呕吐及心动过缓等并发症的发生情况。结果术中地佐辛组与瑞芬太尼组比较,各时点MAP、HR、Narcotrend镇静深度指数基本相似,差异均无统计学意义(P0.05);地佐辛组患者拔管时MAP、HR均低于瑞芬太尼组,拔管后10 min HR低于瑞芬太尼组(P0.05);地佐辛组拔管时及拔管后10 min Narcotrend镇静深度指数均明显低于瑞芬太尼组(P0.05);地佐辛组患者的苏醒、拔除气管导管及离开PACU时间均明显延长(P0.05);地佐辛组患者各时点VAS、SAS评分均降低,而BCS评分升高(P0.05);地佐辛组患者术后48 h呼吸抑制发生率升高(P0.05)。结论腹腔镜直肠癌根治术术中维持使用地佐辛与瑞芬太尼,镇痛效果相当,除呼吸抑制发生率偏高外,在减少术后躁动及痛觉过敏的发生、维持围术期血流动力学平稳等方面效果更佳。
[Abstract]:Objective to compare the analgesic effect of dizosin and remifentanil in radical operation of abdominal rectal cancer. Methods 100 patients with rectal cancer undergoing laparoscopic radical resection were randomly divided into two groups: dizosin group and remifentanil group. Anesthesia analgesia was performed by intravenous infusion of dizosin at a constant velocity of 3 渭 g/(kg / min and remifentanil group by intravenous infusion of remifentanil at a constant rate of 0. 1 渭 g/(kg / min. Intraoperative infusion speed of dizosin or remifentanil was adjusted according to blood pressure and heart rate. Before anesthesia, incision, establishment of pneumoperitoneum, separation of tissues, mean arterial pressure (MAPP), heart rate (HR), anaesthesia depth index, recovery time, extubation time and PACU departure time were recorded 10 min after operation, extubation and extubation. Visual analogue scores (VASA), BCSs (BCSs) and sedation / restlessness scores (SASs) were performed immediately after recovery and at 1 h or 2 h, and the incidence of respiratory depression, nausea and vomiting, bradycardia and other complications were recorded within 48 hours after the operation. Results compared with remifentanil group, the HRH Narcotrend sedation depth index of dizosin group was similar to that of remifentanil group at all time points, and the difference was not statistically significant (P 0.05), and the HR of MAPI in dizosin group was lower than that in remifentanil group during extubation. The HR of 10 min after extubation was lower than that of remifentanil group (P 0.05), the sedation depth index of dizosin group was significantly lower than that of remifentanil group during extubation and 10 min Narcotrend after extubation, the recovery of patients in dizosin group was significantly lower than that in remifentanil group. The extubation of trachea catheter and the time of leaving PACU were significantly prolonged (P0.05), the scores of VASSAs in dizosin group decreased at each time point, but the BCS score increased (P0.05), and the incidence of respiratory inhibition increased 48 hours after operation in the dizoxin group (P 0.05). Conclusion the analgesic effect of using dizosin and remifentanil during laparoscopic radical resection of rectal cancer is similar. Besides the high incidence of respiratory inhibition, it can reduce postoperative restlessness and hyperalgesia. It is better to maintain stable hemodynamics in perioperative period.
【作者单位】：中山大学附属第一医院麻醉科;广东省东莞市谢岗医院麻醉科;
【分类号】：R614;R735.37

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