摘要
目的观察帕金森病患者行下腹部手术术后镇痛效果。方法选择在全身麻醉下行开放性下腹部手术的帕金森病患者21例（PD组）和在全身麻醉下行开放性下腹部手术的非帕金森病患者27例（NP组）,于术前24h分别采用汉密尔顿抑郁量表（HAMD-17）和VAS评分测评患者抑郁和疼痛水平。两组均采用全凭静脉麻醉,术毕前10 min静注芬太尼2μg/kg、托烷司琼2 mg。PCIA泵配方为舒芬太尼200μg＋地佐辛15mg＋托烷司琼6mg,使用生理盐水稀释成150ml,参数设置为背景剂量2 ml/h,冲击剂量0.5 ml,锁定15 min。记录术后4、24、48h静息状态的VAS、Ramsay评分和PCIA泵按压次数及术后48hHAMD-17评分。结果术毕~术后4hPD组PCIA泵按压次数明显少于NP组（P〈0.05）。术后4~48hPD组PCIA泵按压次数明显多于NP组（P〈0.05）。PD组术后24、48h时VAS评分,术后4、24、48h时Ramsay评分明显高于NP组（P〈0.05）。术后48hPD组HAMD-17评分明显高于NP组（P〈0.05）。PD组术后恶心、呕吐、嗜睡等不良反应发生率明显高于NP组（P〈0.05）。线性回归分析显示帕金森病、VAS评分均为术后48h HAMD-17显著预测变量（P〈0.05）。结论帕金森病患者行下腹部手术术后疼痛、镇静程度、抑郁水平均高于非帕金森病患者,且镇痛不良反应亦多于非帕金森病患者。
Objective To observe the analgesic effect in patients with Parkinson disease （PD） after lower abdomen surgery. Methods A total of 21 PD patients （group PD） undergoing open lower abdomen surgery with general anesthesia and 27 non-PD patients （group NP） undergoing open lower abdomen surgery with general anesthesia were evaluated for their depression and pain levels using 17- item Hamilton depression rating scale （HAMD-17） and VAS scor at 24 h before the operation. Both groups received total intravenous anesthesia （TIVA）. Fentanyl 2 μg/kg and tropisetron 2 mg were in- jected intravenously 10 rain before the end of operation. PCIA pump consisted of sufentanil 200μg＋ dezocine 15 mg＋tropisetron 6 mg, which were diluted to 150 ml with 0. 9% normal saline, tMck- ground dose was 2ml/h, loading dose was 0. 5 ml and lockout time was 15 min. VAS score, Ramsay score and PCIA demand times in resting state were recorded 4, 24 and 48 h after operation, and HAMD-17 score was recorded 48 h after operation. Results Four hours after operation, the PCIA de- mand times of group PD was lower than that of group NP （P〈0.05）. At 4-48 h after operation, PCIA demand times of group PD were higher than those of group NP （P〈0.05）. The VAS score at 24, 48 h after operation and at 4, 24 and 48 h after operation, the Ramsay score of group PD was higher than those of group NP （P〈0.05）. At 48 h after operation, the HAMD-17 score of group PD was higher than that of group NP （P〈0. 05）. The incidence of postoperative adverse reactions such as nausea, vomiting and sleepiness in group PD was higher than that in group NP （P〈0. 05）. Linear regression analysis showed that both Parkinson disease and VAS score were significant predictive vari- ables for HAMD-17 score 48 h after operation （P〈0. 05）. Conclusion After lower abdomen surgery, PD patients will have more obvious pain, analgesic adverse reactions, sedation and depression than non-PD patients.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2015年第11期1083-1086,共4页
Journal of Clinical Anesthesiology
关键词
帕金森病
术后镇痛
抑郁
全身麻醉
疼痛
Parkinson＇s disease
Postoperative analgesia
Depression
General anesthesia
Pain
