摘要
目的比较地佐辛与舒芬太尼联合颈神经丛阻滞在老年颈椎间盘切除术中的临床效果。方法选择2016年1月至2017年7月于本院择期行C_(4~5)或C_(5~6)椎间盘切除术的85例老年患者为研究对象,按照随机数表法将入选患者分为地佐辛组(44例)和舒芬太尼组(41例)。两组患者均行颈神经丛阻滞,地佐辛组患者术前15 min给予地佐辛强化麻醉,舒芬太尼组患者术前15 min给予舒芬太尼强化麻醉。比较两组患者血流动力学指标变化情况、术后视觉模拟评分法(visual analogue scale,VAS)评分变化情况、手术前后血糖和血浆皮质醇水平变化情况以及麻醉不良反应发生率。结果两组患者切皮时、术中及术毕平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)均显著高于本组术前(P_均<0.05),且舒芬太尼组患者切皮时、术中及术毕MAP、HR均显著高于同期地佐辛组(P_均<0.05),两组患者手术前后脉搏血氧饱和度均无显著变化(P_均> 0.05)。术后1 h、4 h、8 h,地佐辛组患者VAS评分均显著低于舒芬太尼组(P_均<0.05)。术毕两组患者血糖、血浆皮质醇水平均显著高于本组术前(P_均<0.05),且术毕舒芬太尼组患者血糖、血浆皮质醇水平均显著高于地佐辛组(P_均<0.05)。舒芬太尼组患者不良反应发生率显著高于地佐辛组(χ~2=4.877,P <0.05)。结论地佐辛联合颈神经丛阻滞用于老年颈椎间盘切除术具有良好的镇痛效果,有助于稳定患者术中血流动力学指标,减轻机体应激反应,无明显不良反应,安全有效。
Objective To compare the clinical effects of cervical plexus block combined with Dezocine and Sufentanil in elderly patients undergoing cervical discectomy. Method From January 2016 to July 2017, 85 elderly patients who underwent selective C4 ~ 5 or C5 ~ 6 discectomy in our hospital were selected as the study subjects, according to the random number table method, the patients were divided into Dezocine group(44 cases) and Sufentanil group(41 cases). Nerve block of cervical plexus was performed in both groups, Dezocine group patients were given intensive anesthesia 15 minutes before operation, Sufentanil group patients were received intensive sufentanil anesthesia 15 minutes before operation. The changes of hemodynamic indexes, visual analogue scale(VAS) scores, blood sugar and plasma cortisol levels before and after operation, and the incidence of adverse reactions to anesthesia were compared between the two groups. Result Mean arterial pressure(MAP) and heart rate(HR) were significantly higher in the two groups at the time of skin incision, during and after operation than those before operation(P_(all)< 0.05), and MAP and HR in Sufentanil group were signi?cantly higher than those in Dezocine group at the same time(P_(all)< 0.05). There were no signi?cant changes in pulse oxygen saturation before and after operation in both groups(P_(all)> 0.05). At 1, 4 and 8 hours after operation, the VAS scores of Dezocine group were signi?cantly lower than those in Sufentanil group(P_(all)< 0.05). The levels of blood sugar and plasma cortisol in the two groups after operation were signi?cantly higher than those before operation(P_(all)< 0.05), and the levels of blood sugar and plasma cortisol in Sufentanil group after operation were signi?cantly higher than those in Dezocine group(P_(all)<0.05).The incidence of adverse reactions in Sufentanil group was signi?cantly higher than that in Dezocine group(χ~2= 4.877, P < 0.05).Conclusion Dezocine combined with cervical plexus block has good analgesic effect in elderly patients undergoing cervical discectomy. It is helpful to stabilize the hemodynamic parameters and reduce the body's stress response. It has no obvious adverse reactions and is safe and effective.
引文
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