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地佐辛联合咪达唑仑在玻璃体切割术中镇痛和镇静效果的评价

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DOI:
作者:
项瑛，叶伟娣，孙娜，晋秀明
XIANG Ying, YE Wei-Di, SUN Na, Jing Xiu-Ming
作者单位:
浙江大学医学院附属第二医院
Affiliated Second Hospital of Zhejiang University School of Medicine
关键词:
地佐辛；咪达唑仑；玻璃体切割术；球后阻滞
Dezocine; Midazolam; Vitrectomy; Retrobulbar nerve block
摘要:
目的 评价地佐辛和咪达唑仑联合使用在玻璃体切割术中辅助镇痛和镇静效果。方法 选择160例因视网膜脱离在我院拟行玻璃体切割患者作为研究对象，随机分成4组：地佐辛组给予5mg地佐辛；咪达唑仑组给予2.5mg咪达唑仑；联合组给予5mg地佐辛及2.5mg的咪达唑仑和对照组给予生理盐水。肌注给药后10 min后给予球后神经阻滞。分别于给药前（Tp），手术开始时（T0），手术开始后5 min（T1）、15 min（T2）、30 min（T3）及手术结束时（T4）记录患者平均动脉压（MAP）、心律（HR）、氧饱和度（SpO2）。于T2及T4时间点采用数字评分法（NRS）对疼痛程度进行评分，于术中T2时间点对患者进行Ramsay镇静评分，统计术后恶心呕吐（PONV）情况。结果 咪达唑仑组与联合组在T0-T4点HR均较Tp点有所下降（P<0.05）。在T0，咪达唑仑组和联合组HR比对照组显著下降（P<0.05）。在T1-T4时间点上，只有联合组HR比对照组显著下降（P<0.05）。所有处理组在T0-T4点MAP均较Tp点有所下降（P<0.05），但所有处理组在T0-T4均无显著变化。所有处理组在所有时间点SpO2的差异均无统计学意义（P>0.05）。在T2时间点上，各处理组与对照组在疼痛程度上均有显著下降（P<0.05），且联合组比单用地佐辛或单用咪达唑仑都有显著降低（P<0.05）。在T4时间点上，除咪达唑仑组外，各处理组与对照组在疼痛程度上均有显著下降（P<0.05）。咪达唑仑组和联合组比对照组Ramsay评分有显著升高（P<0.05），单用咪达唑仑组和联合组之间无明显差异（P>0.05）。与对照组相比，地佐辛组PONV发生率明显增高（P < 0. 05），咪达唑仑与联合组患者PONV发生率较地佐辛组显著降低（P < 0. 05），且咪达唑仑组明显低于对照组（P < 0. 05）。结论 局部麻醉辅助地佐辛与咪达唑仑联合使用在玻璃体切割术中镇痛及镇静效果确切。
Objective To compare the analgesic and sedative effects of dezocine and midazolam during vitrectomy under local anesthesia. Methods One-hundred sixty patients with retinal detachment underwent vitrectomy with retrobulbar nerve block were randomly selected into four groups (n=40 each).Control group (Group C): saline were given；dezocine group (group D): 5mg dezocine；midazolam group (group M): 2.5 mg midazolam；combination group (group DM): 5 mg dezocine+2.5mg midazolam. Mean arterial pressure (MAP), heart rate (HR), oxygen saturation (Sp02) were recorded before treatment (Tp) and the beginning of surgery (T0), 5 min (T1),15 min (T2), 30 min (T3) and the end of surgery (T4). Pain at T2 and T4 was assessed using the Numeric Rating Scale (NRS). Level of sedation at T2 was assessed using Ramsay scale. Postoperative nausea and vomiting (PONV) were recorded for 24 hours. Results HR at time point T0-T4 were lower than Tp in group M and DM (p < 0.05). The HR of group D and DM is significantly lower than group C (p < 0.05). At T0, HR of group D and DM is significantly lower than group C (p < 0.05). At T1-T4, HR of group D is significantly lower than group C (p < 0.05).The MAP of all groups decreased significantly at T0 as compared to Tp (p < 0.05) but remain unchanged at T1-T4. SpO2 at each time point of all groups have no significant changes (P>0.05). At T2, all treatment groups have lower pain level than group C (p < 0.05), and the pain level of group DM is significantly lower than group D or group M (P< 0.05). At T4, group D and DM have lower pain level than group C (p < 0.05). Group M and DM shown higher Ramsay score than group C (p < 0.05), and there was no significant difference between group DM and M (P> 0.05). Compared to group C, group D have higher PONV rate (P< 0.05). Group M and DM have lower PONV rate than group D (P< 0.05), group M have lower PONV rate than group C (P < 0.05). Conclusion Combinatory use of dezocine and midazolam had efficient analgesic and sedative effects during vitrectomy under local anesthesia.

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