目的 观察地佐辛与纳布啡预防蛛网膜下腔阻滞麻醉下行吻合器痔上黏膜环切钉合术(procedure for prolapse and hemorrhoids，PPH)时患者内脏牵拉反应的临床效果。方法 将80例在蛛网膜下腔阻滞麻醉下，行PPH的患者随机分为地佐辛组(n=40)和纳布啡组(n=40)。经B超引导定位标记腰椎3～4间隙，进行穿刺麻醉，手术开始时，地佐辛组单次静脉注射地佐辛0。15mg/kg，纳布啡组单次静脉注射纳布啡0。08mg/kg。观察并比较术前(T1)、置入固定扩肛器时(T2)、旋紧吻合器时(T3)及手术结束时(T4)两组患者生命体征(HR、SBP、DBP、SpO2)的变化。同时观察两组患者手术时牵拉反应的程度及术后不良反应发生情况。结果 两组患者T1～T4时HR、SBP、DBP、SpO2比较，差异均无统计学意义(P＞0。05)。两组患者T1时SpO2较T2～T4时低(P＜0。05)。地佐辛组T3时HR、SBP、DBP较T1、T2、T4时明显升高(P＜0。01);T4时HR、SBP、DBP较T3时升高(P＜0。05)。纳布啡组T3时HR、SBP、DBP较T1、T2时升高(P＜0。05);T4时HR、DBP较T2时明显下降(P＜0。01);T4时SBP、DBP较T3时下降(P＜0。05)。两组患者T1、T4时HR、SBP、DBP比较，差异均无统计学意义(P＞0。05)。地佐辛组T3时HR、SBP、DBP较T1、T2、T4时明显升高(P＜0。01)。纳布啡组T3时SBP、DBP较T1、T2、T4时明显升高(P＜0。01)。纳布啡组T2时HR较T1、T3、T4时明显下降(P＜0。01)。地佐辛组T2时HR较纳布啡组升高(P＜0。05或P＜0。01)。两组脉搏氧饱和度差异无统计学意义(P＞0。05)。地佐辛组术中牵拉反应程度高于纳布啡组(P＜0。01)。两组患者眩晕差异无统计学意义(P＞0。05)。结论 蛛网膜下腔阻滞PPH术中辅助使用纳布啡能取得较地佐辛更佳的疗效，患者的牵拉反应和不良反应更少，舒适度更高，是一种安全有效的麻醉方式，值得临床推荐。
Clinical Effect Observation of Dexamethasone and Nabrphine on Visceral Traction Reaction Prevention during Stapler Hemorrhoid Submucosal Circumcision
Objective To observe clinical effect of dexamethasone and nalbuphine in preventing visceral traction reactions of patients with procedure for prolapse and hemorrhoids(PPH)under subarachnoid block anesthesia.Methods The paper chose 80 patients with PPH under subarachnoid block anesthesia,and divided them into dexamethasone group(D group,n=40)and nalbuphine group(N group,n=40)randomly.Guided by B-ultrasound,lumbar vertebrae 3～4 spaces were marked for puncture anesthesia.At beginning of the surgery,group D was treated with single intravenous injection of 0.15mg/kg of dexamethasone,while group N with single intravenous injection of 0.08mg/kg of nalbuphine.Changes of vital signs(HR,SBP,DBP,SpO2)were observed and compared between two groups before surgery(T1),during placement of fixed anal dilator(T2),during tightening of the stapler(T3),and at end of surgery(T4).Degree of traction reactions during surgery and incidence of postoperative adverse reactions was observed simultaneously between two groups.There was no statistically significant difference in HR,SBP,DBP,and SpO2 between two groups at T1 to T4(P＞0.05).In the two groups,SpO2 was lower at T1 than at T2 to T4(P＜0.05).HR,SBP,and DBP in Dezosin group was significant higher at T3 than T1,T2,and T4(P＜0.01),and the HR,SBP,and DBP at T4 were significantly higher than those at T3(P＜0.05).In the nalbuphine group,HR,SBP and DBP were significantly higher than those at T1 and T2(P＜0.05),and significantly lower at T4 than at T2(P＜0.01).SBP and DBP decreased at T4 compared with T3(P＜0.05).Conclusion Adjuvant application of nalbuphine during subarachnoid block PPH can achieve better curative effect than dexamethasone,with fewer traction and adverse reactions,higher comfort,which is a safe and effective anesthesia method,and worthy of clinical recommendation.
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