摘要
目的探讨地佐辛在胆囊息肉患者腹腔镜胆囊切除术(LC)术后镇痛的应用效果。方法入选行LC治疗的胆囊息肉患者,根据术后镇痛药物分为对照组(给予舒芬太尼术后镇痛)和试验组(给予地佐辛联合舒芬太尼术后镇痛)。比较2组患者的疼痛视觉模拟评分(VAS)、Ramsay镇静评分(RSS)、平均动脉压(MAP)、心率(HR)、应激激素[皮质醇(Cor)、儿茶酚胺(CA)、去甲肾上腺素(NE)]及药物不良反应发生情况。结果对照组入组47例患者,试验组入组55例患者。试验组T1~T3时刻的MAP分别为(90.95±16.23)、(93.27±10.95)和(89.80±13.18)mmHg,均显著低于对照组[分别为(110.60±15.51)、(103.26±12.85)和(104.28±13.09)mmHg(均P<0.05)],试验组T1~T3时刻的HR分别为(72.69±6.73)、(75.69±6.73)和(70.67±7.62)beat·min^(-1),均显著低于对照组[分别为(86.32±12.01)、(81.47±9.93)和(81.40±8.14)beat·min^(-1)(均P<0.05)]。试验组T5、T6时刻VAS评分分别为3(2,3)和2(2,3)分,均显著低于对照组[分别为3(3,4)和3(3,3)分(均P<0.05)];试验组T5时刻RSS评分为2(2,2)分,显著高于对照组的2(1,2)分(P<0.05)。试验组T4、T5时刻的Cor分别为(279.04±31.42)和(308.78±41.73)nmol·L^(-1),均显著低于对照组[分别为(326.29±38.51)和(356.94±43.76)nmol·L^(-1)(均P<0.05)],CA分别为(232.85±31.99)和(241.50±30.11)pg·mL^(-1),均显著低于对照组[分别为(263.18±37.51)和(291.25±33.27)pg·mL^(-1)(均P<0.05)],NE分别为(163.21±25.97)和(192.26±28.69)ng·L^(-1),均显著低于对照组[分别为(194.99±22.66)和(213.74±32.27)ng·L^(-1)(均P<0.05)]。对照组发生的药物不良反应主要有嗜睡、恶心呕吐、呼吸抑制,药物不良反应发生率为19.15%;试验组发生的药物不良反应主要有嗜睡、恶心呕吐,药物不良反应发生率为5.45%,试验组的药物不良反应发生率显著低于对照组(P<0.05)。结论地佐辛联合舒芬太尼应用于胆囊息肉患者LC术后镇痛,能够显著缓解患者疼痛程度,并减轻由术后疼痛继发的应激反应。
Objective To explore the analgesic effect of dezocine in patients with gallbladder polyps after laparoscopic cholecystectomy(LC).Methods Patients with gallbladder polyps undergoing LC were enrolled.According to postoperative analgesics,they were divided into control group(sufentanil)and treatment group(dezocine combined with sufentanil).The scores of visual analogue scale(VAS)and Ramsay sedation scale(RSS),mean arterial pressure(MAP),heart rate(HR),stress hormones[cortisol(Cor),catecholamine(CA),norepinephrine(NE)]and the occurrence of adverse reactions were compared between the two groups.Results There were 47 subjects in the control group and 55 subjects in the treatment group.The MAP values at T1-T3 in the treatment group were(90.95±16.23),(93.27±10.95),and(89.80±13.18)mmHg,which were significantly lower than those in the control group[(110.60±15.51),(103.26±12.85),and(104.28±13.09)mmHg](all P<0.05).The HR values at T1-T3 in the treatment group were(72.69±6.73),(75.69±6.73),and(70.67±7.62)beats·min^(-1),which were significantly lower than those in the control group[(86.32±12.01),(81.47±9.93),and(81.40±8.14)beats·min^(-1)](all P<0.05).The VAS scores at T5 and T6 in the treatment group were 3(2,3)and 2(2,3),significantly lower than those in the control group[3(3,4)and 3(3,3)](all P<0.05).The RSS score at T5 in the treatment group was 2(2,2),significantly higher than that in the control group[2(1,2)](P<0.05).The Cor levels at T4 and T5 in the treatment group were(279.04±31.42)and(308.78±41.73)nmol·L^(-1),significantly lower than those in the control group[(326.29±38.51)and(356.94±43.76)nmol·L^(-1)](all P<0.05).The CA levels at T4 and T5 in the treatment group were(232.85±31.99)and(241.50±30.11)pg·mL^(-1),significantly lower than those in the control group[(263.18±37.51)and(291,25±33.27)pg·mL^(-1)](all P<0.05).The NE levels at T4 and T5 in the treatment group were(163.21±25.97)and(192.26±28.69)ng·L^(-1),significantly lower than those in the control group[(194.99±22.66)and(213.74±32.27)ng·L^(-1)](all P<0.05).The adverse drug reactions that occurred in the control group mainly included sedation,nausea,vomiting,and respiratory suppression,with incidence rate of 19.15%The adverse drug reactions that occurred in the treatment group mainly included sedation and nausea,with incidence rate of 5.45%.The incidence rate of adverse drug reactions in the treatment group was significantly lower than that in the control group(P<0.05).Conclusion Dezocine combined with sufentanil for postoperative analgesia can significantly relieve pain,relieve stress response secondary to postoperative pain and reduce the occurrence of anesthesia-related adverse reactions in patients with gallbladder polyps after LC.
作者
李天文
张佳华
高福洋
LI Tian-wen;ZHANG Jia-hua;GAO Fu-yang(Graduate School,Chengde Medical College,Chengde 067000,Hebei Province,China;Department of General Surgery,ChengdeeCentral Hospital(SecondClinical College of Chengde Medical College),Chengde 067000,Hebei Province,China)
出处
《中国临床药理学杂志》
CAS
CSCD
北大核心
2023年第23期3388-3392,共5页
The Chinese Journal of Clinical Pharmacology
关键词
地佐辛
舒芬太尼
胆囊息肉
腹腔镜胆囊切除术
术后镇痛
应激反应
dezocine
sufentanil
gallbladder polyp
laparoscopic cholecystectomy
postoperative analgesia
stress response
