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Received:September 01, 2020 Published Online:June 20, 2021
Received:September 01, 2020 Published Online:June 20, 2021
中文摘要: 目的 观察静脉注射地佐辛与托烷司琼用于预防鞘内注射吗啡镇痛所致皮肤瘙痒的临床效果。方法 选择山西白求恩医院2020年3月至7月择期在蛛网膜下腔阻滞麻醉下行半月板成形术患者120例,采用随机数字表法分为麻醉前不同预处理4组,每组30例:对照组(C组,生理盐水3 ml)、地佐辛组(D组,地佐辛5 mg)、托烷司琼组(T组,托烷司琼5 mg)和地佐辛+托烷司琼组(DT组,地佐辛5 mg+托烷司琼5 mg),均于麻醉前10 min静脉注射,药液均加生理盐水至3 ml;所有患者于L3~4间隙行蛛网膜下腔阻滞麻醉，穿刺成功后于蛛网膜下腔给予吗啡0.3 mg和1%罗哌卡因2 ml。记录患者给药后24 h内瘙痒程度分级,同时记录Ramsay镇静评分、VAS评分和恶心呕吐、寒战、呼吸抑制等不良反应的发生情况。统计学检验水准取α=0.05,采用R×C表χ2检验分割法时,校正为α'=0.008 3。结果 蛛网膜下腔给药后至术后24 h内,C组、D组、T组、DT组瘙痒总发生率分别为60.0%、30.0%、33.3%和10.0%,四组患者皮肤瘙痒总发生率差异有统计学意义(χ2=17.100,P=0.001);两两比较发现,D组、T组、DT组瘙痒总发生率分别较C组明显降低(P<0.008 3),且以DT组瘙痒总发生率最低。四组间VAS评分及不良反应发生率差异无统计学意义(P>0.05)。结论 地佐辛和托烷司琼预处理可以有效缓解鞘内注射吗啡镇痛所致的瘙痒,患者的舒适度、满意度更高。
Abstract:Objective To observe the clinical effect of intravenous injection of dezocine and tropisetron in preventing skin pruritus caused by intrathecal morphine analgesia. Methods A total of 120 patients who received elective meniscusplasty under spinal anesthesia at Shanxi Bethune Hospitial from March 2020 to July 2020 were selected.The patients were divided into four groups by random number table method,30 cases in each group:control group (group C),dezocin group (group D),tropisetron group (group T) and dezocin+ tropisetron group (group DT).Group C was intravenously injected 3 ml normal saline,group D was intravenously injected dezocine 5 mg (added normal saline to 3 ml),group T was intravenously injected tropisetron 5 mg(added normal saline to 3 ml) and group DT was intravenously injected dezocin 5 mg+ tropisetron 5 mg(added normal saline to 3 ml) 10 min before spinal anesthesia.All patients received spinal anesthesia in L3~4 interspace and subarachnoid injection of morphine 0.3 mg and 1% ropivacaine 2 ml.Pruritus severity score in 24 h after administration,Ramsay sedation score,VAS scale,and adverse reactions (such as nausea,vomiting,chills and respiratory depression) were recorded.
The statistical test level was α=0.05,and when using the R×C table chi-square test segmentation method,it was corrected to α′=0.008 3. Results Within 24 h after subarachnoid administration,the total incidences of pruritus in group C,group D,group T and group DT were 60.0%,30.0%,33.3% and 10.0%,respectively,and the difference was significant among them（χ2=17.100，P=0.001）.Pairwise comparison showed that the incidence of pruritus significantly decreased in group D,group T and group DT compared to group C(P＜0.008 3),with the lowest in group DT.In addition,there was no significant difference in VAS scores and incidences of adverse reactions among the four groups(P>0.05). Conclusion Pretreatment with dezocin and tropisetron can effectively relieve pruritus caused by intrathecal morphine analgesia,which has a higher degree of comfort and satisfaction of patients.
keywords: ntrathecal injection Morphine Dezocine Tropisetron Pruritus
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基金项目:山西省科学技术厅重点研发计划项目(201703D321027-6)
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