摘要
目的分析在腹腔镜下胆囊切除术中应用地佐辛复合不同麻醉药物预防性镇痛的效果及对应激反应的影响。方法90例患者均为2018年1月—2021年1月在承德医学院附属医院实施腹腔镜下胆囊切除术者,采用随机数字表将患者分为A组和B组,每组45例。A组使用右美托咪定复合地佐辛预防性镇痛;B组使用异丙酚复合地佐辛预防性镇痛。比较两组拔管不同时间的警觉-镇静量表(Observer assessment of sedation,OAAS)评分、手术前后不同时间的简易精神状态检查量表(Minimental state examination,MMSE)评分、疼痛视觉模拟评分(Visual analogue score,VAS)及术后不同时间的皮质醇(Cortisol,Cor)、去甲肾上腺素(Norepinephrine,NE)等应激指标水平,统计两组麻醉不良反应发生情况。结果两组离开手术室与拔管后1 h的OAAS评分高于拔管时,且拔管后1 h OAAS评分高于离开手术室(P<0.05);A组拔管时与离开手术室的OAAS评分均高于B组(P<0.05)。两组术后12 h MMES评分均低于术前,术后24 h高于术后12 h(P<0.05)。术后2~24 h,两组VAS评分逐渐降低(P<0.05),A组术后2 h与术后6 h均低于B组(P<0.05)。两组内术后12 h与术后24 h的血清Cor、NE水平均高于术前,术后24 h均低于术后12 h(P<0.05)。A组术后12 h与术后24 h的血清Cor与NE水平均低于B组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论地佐辛复合右美托咪定预防性镇痛用于腹腔镜下胆囊切除中较地佐辛复合异丙酚的镇痛、镇静和抑制应激反应作用更优,两种方案对术后认知功能的影响及安全性相当。
Objective To analyze the effect of dezocine combined with the different anesthetics on preventive analgesia and the stress response in laparoscopic cholecystectomy.Methods Ninety patients were performed laparoscopic chole⁃cystectomy in the hospital from January 2018 to January 2021.Using a random number table,the patients were divided into group A and group B,with 45 cases in each group.Group A used dexmedetomidine combined with dezocine for preventive analgesia.Group B used propofol combined with dizocine for preventive analgesia.The Observer Assess⁃ment of Sedation(OAAS)scores at different times of extubation,the Mini-Mental State Examination(MMSE),Pain Vi⁃sual Analog Score(VAS)at different times before and after surgery,and the levels of stress indicators[Cortisol(Cor),Norepinephrine(NE)]at different times after surgery were compared between the two groups,and the incidence of ad⁃verse anesthetic reactions in the two groups were counted.Results The OAAS scores of the two groups leaving the op⁃erating room,and 1 hour after extubation were higher than those at the time of extubation,and the OAAS score at 1 hour after extubation was higher than that leaving the operating room(P<0.05).The OAAS scores of group A at the time of extubation and leaving the operating room were higher than those in group B(P<0.05).The MMES scores at 12 hours after operation in both groups were lower than those before operation,and higher at 24 hours after operation than at 12 hours after operation(P<0.05).From 2 h to 24 h after the operation,the VAS scores of the two groups gradually decreased(P<0.05).Group A was lower than group B at 2 hours and 6 hours after operation(P<0.05).The levels of se⁃rum Cor and NE at 12 hours and 24 hours after operation in the two groups were higher than those before operation,which at 24 hours after operation were lower than those at 12 hours after operation(P<0.05).The serum levels of Cor and NE in group A at 12 h and 24 h after operation were lower than those in group B(P<0.05).There was no signifi⁃cant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Dezocine combined with dexmedetomidine for preventive analgesia in laparoscopic cholecystectomy is better than dezocine combined with propofol in analgesia,sedation and suppression of stress response.The two programs have better effects on postopera⁃tive analgesia.The impact and safety of cognitive function are equivalent.
作者
宋莺春
徐飞
SONG Yingchun;XU Fei(Department of Anesthesiology,Affiliated Hospital of Chengde Medical College,Chengde Hebei 067000,China)
出处
《新疆医科大学学报》
CAS
2022年第4期425-428,共4页
Journal of Xinjiang Medical University
基金
河北省自然科学基金(1010101)。
