Effect of remifentanil versus dezocine analgesia in middle pregnancy abortion
-
摘要:目的 比较瑞芬太尼与地佐辛在中期妊娠引产镇痛中的应用效果。方法 选择中期妊娠引产患者80例随机分为R组与D组，每组40例。R组采用瑞芬太尼0.05~0.15 μg/(kg·min)微量泵静脉输注镇痛，随时调整用药以达到并维持镇痛所需水平; D组采用地佐辛25 mg, 稀释至50 mL生理盐水中，背景剂量10 mL/h, 单次剂量5 mL/h静脉自控镇痛。记录2组视觉模拟评分法(VAS)疼痛评分、Ramsay镇静评分、镇痛调节次数、引产后第一疼痛时间以及呼吸抑制、心动过缓、恶心呕吐等不良反应发生情况。结果 镇痛结束后30 min, R组VAS评分(7.5±1.2)分显著高于D组(2.3±1.1)分(P < 0.05); R组Ramsay评分(2.5±0.2)分显著高于D组(2.3±0.3)分(P < 0.05); R组镇痛调节次数显著多于D组，第一疼痛时间显著短于D组，心动过缓、呼吸抑制的发生率显著高于D组(P < 0.05)。结论 与瑞芬太尼相比，地佐辛静脉自控镇痛用于妊娠中期引产操作更方便，孕妇易配合，可避免产生痛觉过敏，且不良反应发生率更低。Abstract:Objective To compare the effect of remifentanil and dezocine analgesia in middle pregnancy abortion.Methods A total of 80 middle pregnant induced labor cases were randomly divided into group R and group D, with 40 cases in each group. Group R was given intravenous infusion of remifentanil for analgesia at a dosage of 0.05~0.15 μg/(kg·min) by micro pump, and the dosage was adjusted to reach and maintain the level of analgesia. Group D was given 25 mg dezocine diluted to 50 mL normal saline, with abackground dose of 10 mL/h. A single intravenous analgesia dose of 5 mL/h was given to theses patients for intravenous self-controlled analgesia. Visual Analogue Scale (VAS) Scores, Ramsay sedation score, adjust times of analgesia, time to first pain after induction and occurrence of complications such as respiratory depression, bradycardia, nausea and vomiting were recorded.Results At 30 min after analgesia, the VAS score in the R group was significantly higher than that in group D[(7.5±1.2) vs. (2.3±1.1), P < 0.05]; the Ramsay score in the group R was significantly higher than that in the group D [(2.5±0.2) vs. (2.3±0.3), P < 0.05); the times of analgesic adjustment in group R was significantly more, the time to first pain was significantly shorter, and the incidences of bradycardia and respiratory depression were significantly higher than that of group D (P < 0.05).Conclusion Compared with remifentanil, dezocine intravenous analgesia for middle pregnancy abortion women with easy operation and cooperation can avoid the occurrence of hyperalgesia, and reduce incidence of adverse reactions.
-
Keywords:
- middle pregnancy abortion /
- remifentanil /
- dezocine /
- analgesic /
- opioid /
- hyperalgesia
-
-
表 1 2组患者各时点VAS评分和Ramsay评分比较(x±s)
分 组别 指标 T1时点 T2时点 T3时点 T4时点 R组(n=40) VAS评分 6.9±1.5 4.6±1.2 2.5±1.5 7.5±1.2 Ramsay评分 2.1±0.5 3.6±1.0 4.5±1.2 2.5±0.2 D组(n=40) VAS评分 7.0±1.6 4.7±1.5 2.8±1.2 2.3±1.1* Ramsay评分 2.1±0.4 2.2±0.5* 2.8±0.6* 2.3±0.3 VAS: 视觉模拟评分法。与R组比较, *P < 0.05。 
下载: 导出CSV
表 2 2组患者引产镇痛不良反应发生情况比较[n(%)]
组别 n 心动过缓 恶心呕吐 呼吸抑制 R组 40 11(27.5) 2(5.0) 9(22.5) D组 40 0* 3(7.5) 0* 与R组比较, *P < 0.05。
下载: 导出CSV
-
[1] Orbach-Zinger S, Paul-Keslin L, Nichinson E, et al. Tramadol-metoclopramide or remifentanil for patient-controlled analgesia during second trimester abortion: a double-blinded, randomized controlled trial[J]. J Clin Anesth, 2012, 24(1): 28-32. doi: 10.1016/j.jclinane.2011.05.003
[2] Song J W, Lee Y W, Yoon K B, et al. Magnesium sulfate prevents remifentanil-induced postoperative hyperalgesia in patients undergoing thyroidectomy[J]. Anesth Analg, 2011, 113(2): 390-397. doi: 10.1213/ANE.0b013e31821d72bc
[3] Lee C, Kim Y D, Kim J N. Antihyperalgesic effects of dexmedetomidine on high-dose remifentanil-induced hyperalgesia[J]. Korean J Anesthesiol, 2013, 64(4): 301-307. doi: 10.4097/kjae.2013.64.4.301
[4] Wang C Y, Li L Z, Shen B X, et al. A multicenter randomized double-blind prospective study of the postoperative patient controlled intravenous analgesia effects of dezocine in elderly patients[J]. Int J Clin Exp Med, 2014, 7(3): 530-539. http://pubmedcentralcanada.ca/pmcc/articles/PMC3992390/
[5] Song Y K, Lee C, Seo D H, et al. Interaction between postoperative shivering and hyperalgesia caused by high-dose remifentanil[J]. Korean J Anesthesiol, 2014, 66(1): 44-51. doi: 10.4097/kjae.2014.66.1.44
[6] Kim S H, Stoicea N, Soghomonyan S, et al. Intraoperative use of remifentanil and opioid induced hyperalgesia/acute opioid tolerance: systematic review[J]. Front Pharmacol, 2014, 5: 108-108. http://pubmedcentralcanada.ca/pmcc/articles/PMC4021143/?lang=fr
[7] Wang Z P, Edwards J G, Riley N, et al. Myosin Vb mobilizes recycling endosomes and AMPA receptors for postsynaptic plasticity[J]. Cell, 2008, 135(3): 535-548. doi: 10.1016/j.cell.2008.09.057
[8] 刘颖群, 李萱, 程畅河, 等. 地佐辛联合罗哌卡因在中期妊娠引产镇痛中的应用研究[J]. 中国基层医药, 2014, 21(18): 2824-2825. doi: 10.3760/cma.j.issn.1008-6706.2014.18.044 [9] 徐维娟, 马军, 徐桂萍. 地佐辛不同给药时机对子宫肌瘤患者术后镇痛效果及淋巴免疫系统的影响[J]. 中国基层医药, 2013(20): 3119-3121. doi: 10.3760/cma.j.issn.1008-6706.2013.20.033 [10] 高丽娜, 衣丽丽, 丁浩, 等. 瑞芬太尼预注射在中期妊娠引产中的效果研究[J]. 中国处方药, 2015, 13(2): 119-120. doi: 10.3969/j.issn.1671-945X.2015.02.095 [11] 杨华平. 中期妊娠引产镇痛过程中地佐辛联合罗哌卡因的应用探讨[J]. 中外医疗, 2017, 36(1): 106-108. https://www.cnki.com.cn/Article/CJFDTOTAL-HZZZ201701039.htm [12] 孙冰, 张丕兴, 田瑞云, 等. 瑞芬太尼PCIA与罗哌卡因PCEA在中期妊娠引产术中的应用[J]. 临床麻醉学杂志, 2011, 27(2): 191-192. https://www.cnki.com.cn/Article/CJFDTOTAL-LCMZ201102039.htm [13] 王玥, 康凯, 车向明, 等. 硬膜外阻滞在中期妊娠引产镇痛时机选择的临床观察[J]. 北京医学, 2014, 36(11): 930-932. doi: 10.3969/j.issn.0253-9713.2014.11.018
计量
- 文章访问数: 276
- HTML全文浏览量: 122
- PDF下载量: 5
苏公网安备 32100302010246号
