摘要
目的比较不同时间给予曲马朵对预防瑞芬太尼麻醉后早期疼痛的效果及不良反应。方法选择全身麻醉下行开腹妇科手术的患者120例，全麻诱导后以异氟烷、瑞芬太尼维持麻醉。随机分为3组：A组在手术结束前30min静脉注射曲马朵2mg／kg，B组在手术结束时给予曲马朵2mg／kg，C组在气管拔管后给予曲马朵2mg／kg。记录手术结束到患者恢复自主呼吸的时间、气管拔管的时间、每隔10min的疼痛VPS评分及OAAS评分，并记录各项生命体征和不良反应。苏醒后30min内VPS评分≥2者视为镇痛失败。结果三组患者手术结束后自主呼吸恢复时间、气管拔管时间以及各时点心率、血压均无统计学差异，但拔管后10min C组spO2显著低于A、B两组。苏醒后20和30minB组VPS评分较低，镇痛失败的患者少于A、C两组，且P〈0．05。结论在预防瑞芬太尼麻醉后早期疼痛上，手术结束时给予曲马朵的效果优于提前30min给药和苏醒后给药，且不影响苏醒时间。
Objective To determine the optimal intervening time-point of tramadol for early postoperative pain control after remifentanil-based anesthesia. Methods One hundred and twenty patients, aged from 18-59 years, scheduled for major selective gynecologic surgery （lasting more than 1 hour） under general anesthesia were included in this study. The anesthesia was maintained with isoflurane （1%-2%） and remifentanil （0.1-0.2 μg/kg ·min）. Depending on the randomization, the patients received tramadol 2 mg/kg 30 min before the end of surgery in group A, when remifentanil infusion was discontinued in group B, and immediately after tracheal extubation in group C respectively. Time for recovery of spontaneous respiration and time for tracheal extubation after the end of surgery were recorded. The VPS score （0-3） and OAAS score （0-4） 10, 20, 30 minutes after extubation were recorded as well as the vital signs by a PACU nurse with blind method. Results Time for recovery of spontaneous respiration and time for tracheal extubation were similar among the three groups. And vital signs in PACU showed no significant statistical difference except that SpO2 values in group C measured 10 minutes alter tracheal extubation were lower than those in other groups （P〈0.05）. At 20, 30 minutes after tracheal extubation, VPS scores were lower in group B than those in group A and C, and the cases with a VPS score≥2 were less in group B （P〈0.05）. Conclusion Administration of tramadol 2mg/kg in different time-points of remifentanil-based anesthesia provides similar recovery time and extubation time postanesthesia, while better analgesic effect is obtained in group B. It＇s concluded that the optimal intervening time-point of tramadol for immediate postoperative analgesia after remifentanil- based anesthesia is at the stop of remifentanil infusion.
出处
《实用疼痛学杂志》
2009年第1期18-21,共4页
Pain Clinic Journal
关键词
曲马朵
瑞芬太尼
术后镇痛
Tramadol
Remifentanil
Post-operative Analgesia
