地佐辛对上腹部全麻手术后拔管的效果评估

Effect of dezocine on removal of tracheal catheter after epigastric operation under general anesthesia

  • 摘要: 目的 观察地佐辛抑制上腹部全麻患者术后气管拔管应激反应的效果和对患者意识,呼吸恢复的影响。 方法 80例择期上腹部手术患者随机分为地佐辛组(D组)和对照组(C组)各40例,术毕前15min停用依托咪酯,前3min停用瑞芬太尼,术毕前15min D组静注地佐辛5mg,C组静注0.9%氯化钠注射液5ml。分别于入室后诱导前(T0)、拔管后1min (T1)、3min (T2)、5min (T3)记录收缩压、舒张压、平均动脉压、心率,计算心率与收缩压乘积,并于各时点采集颈内静脉血,采用葡萄糖氧化酶法测定血糖,放射免疫法检测皮质醇浓度,记录患者清醒时间、拔管时间及拔管时患者是否出现躁动。 结果 T1-T3时C组MAP、HR、RPP均明显高于T0时(P<0.05),T1-T3时MAP、HR、RPPD组均明显低于C组(P<0.05),T1-T3时C组血糖、皮质醇均明显高于T0时(P<0.05),T1-T3时D组血糖、皮质醇均明显低于C组(P<0.05),拔管时D组躁动发生率明显低于C组(P<0.05),患者清醒时间及拔管时间两组差异无统计学意义(P>0.05)。 结论 全麻患者拔管前静注地佐辛可抑制拔管期的应激反应,而不影响意识恢复和呼吸恢复,不延长拔管时间。

     

    Abstract: Objective To observe the effect of dezocine on tracheal catheter removal after epigastic operation under general anesthesia,including stress,consciousness,and recovery of respiration. Methods Eighty patients undergoing epigastric operation were randomly divided into dezocine group(group D) and control group(group C),40 in each group.Etomidate and remifentanil were withdrawn from the patients in group D 15 and 3min respectively before operation,who were then infused with dezocine(5mg) through the vein 15min by the end of operation.Patients in group C were infused with 5ml 0.9% sodium chloride solution.Their SBP,DBP,MAP,and HR were measured before operation(T0),1 minute after operation(T1),3 minutes after operation(T2) and 5 minutes after operation(T3).Their RPP was calculated.Blood sample was collected from internal jugular vein.Blood glucose and cortisol levels were measured by glucose-oxidase and radioimmunoassay.Wakeup and tracheal catheter removal time,and dysphoria during tracheal catheter removal were recorded. Results The MAP,HR and RPP were significantly lower in group C than in group D at T1-T3(P<0.05).The blood glucose and cortisol levels were significantly higher in group D than in group C at T1-T3(P<0.05).The incidence of dysphoria was significantly lower in group D than in group C during tracheal catheter removal(P<0.05).No significant difference was found in wakeup and tracheal catheter removal time between the two groups(P>0.05). Conclusion Intraveinous injection of dezocine can inhibit stress to tracheal catheter removal under general anesthesia without affecting the wakeup and respiration recovery of patients.

     

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