微创医学

目的观察地佐辛联合氟比洛芬酯对妇科腔镜术后疼痛及致痛物质的影响。方法择期行妇科腔镜手术患者60例,美国麻醉医师协会(ASA)分级Ⅰ级或Ⅱ级,随机分为三组:地佐辛组(D组)20例、地佐辛复合氟比洛芬酯组(DF组)20例、氟比洛芬酯组(F组)20例。在术后静脉自控镇痛(PCIA)开始后的4、12、24、48 h采用视觉模拟评分(VAS)观察镇痛效果,用Ramsay法观察镇静效果及舒适度(BCS)评级;测定麻醉前、术后12、24、48 h血清五羟色胺(5-HT)和P物质(PS)浓度;记录术后48 h内患者的不良反应。结果与F组比较,术后4、12、24 h D组和DF组VAS评分明显降低、BCS评级明显升高(P<0.05);术后4、12、24 h D组Ramsay评分明显升高(P<0.05)。与麻醉前比较,三组患者术后12、24、48 h血清5-HT和PS浓度明显升高(P<0.05)。与F组比较术后12、24、48 h D和DF组血清5-HT和PS浓度明显降低(P<0.05)。与D组比较,DF组和F组头晕、嗜睡发生率明显降低(P<0.05)。结论地佐辛联合氟比洛芬酯对妇科腔镜术后静脉自控镇痛(PCIA),可提供良好的镇痛效果,抑制术后五羟色胺和P物质浓度的升高,不良反应少。

Objective To observe the effect of dezocine combined with flurbiprofen axetil on postoperative pain and algogenic substance in patients treated by laparoscopic gynecology. Method 60 patients to be conducted gynecological laparoscopy,who were graded as I or II by American Society of Anesthesiology (ASA),were randomly divided into three groups:dezocine group (D group,n = 20),dezocine combined with flurbiprofen (DF group,n =20)and flurbiprofen axetil group (F group,n =20). At the 4th,12th 24th and 48th hour since the beginning of postoperative patientcontrolled intravenous analgesia (PCIA),the analgesic effect was evaluated using the visual analogue score(VAS);the sedative effect and degree of comfort (BCS)were rated by using Ramsay method;the concentration of serum five hydroxytryptamine(5HT)and P substance(PS)were measured before anesthesia,and at 12th,24th and 48th hour after the operation; Adverse reactions of patients with 48 hours after operation were recorded. Results VAS score of patients in D Group and DF Group in 4 hours,12 hours and 24 hours significantly decreased after surgeries when compared to that of patients in Group F,while BCS score increased significantly (P < 0. 05). Ramsay score increased significantly in 4 hours,12 hours and 24 hours after surgeries (P < 0. 05). 5HT and PS concentration in serums of patients in three groups in 12 hours,24 hours and 48 hours after surgeries increased significantly when compared to those indexes in serums of patients before anesthesia (P < 0. 05 ). 5HT and PS concentrations in serums of patients in Group D and Group DF in 12 hours,24 hours and 48 hours after surgeries significantly decreased when compared with those indexes in serums of patients in Group F (P <0. 05). The incidence of dizziness and sleepiness of patients in Group DF and Group F significantly decreased when compared to that of patients in Group D (P <0. 05). Conclusions Dezocine combined with Flurbiprofen Axetil may deliver a good analgesia effect on patientcontrolled intravenous analgesia after gynecological laparoscopic operations,and inhibit the increase in the concentration of Serotonin and of Substance P after operations,with few adverse reactions.