摘要
目的 探讨芬太尼和曲马多对预防全麻后苏醒期躁动的临床效果、不良反应和安全性.方法 120例ASAⅡ级的择期腹腔镜手术患者,随机分为曲马多组（Q组）60例,其中曲马多分为1、2、3 mg/kg组（Q1、Q2、Q3组）,每组20例;芬太尼组（F组）60例,其中芬太尼分为0.1、0.2、0.3μg/kg组（F1、F2、F3组）,每组20例.两组病人麻醉诱导芬太尼2μg·kg-1、阿曲库铵0.5mg·kg-1、丙泊酚2mg·kg-1,麻醉维持吸入1%～3%异氟醚,丙泊酚5mg·kg-1·h-1和阿曲库铵5 mg·kg-1·h-1.术中监测收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO2）和呼末二氧化碳（PETCO2）.术毕前30min Q1、Q2和Q3组分别缓慢静脉输入曲马多1、2和3mg/kg,F1、F2和F3组分别缓慢静脉输入芬太尼0.1、0.2和0.3μg/kg.观察拔管前、拔管时、拔管后10min各组的躁动评分（RS）、镇静评分（RSS）和意识状态评分（OAAS）.观察各组用药对呼吸和循环系统的影响.结果 F组RS评分低于Q组（P＜0.05）;F组OAAS评分高于Q组（P＜0.05）;两组Ramsay评分差异无显著性（P＞0.05）;F组患者术后躁动发生率明显低于Q组,其中F组患者中F2组优于F1组和F3组（P＜0.05）.两组患者术后未见恶心、呕吐、消化道出血、严重呼吸抑制等不良反应.结论 芬太尼用于预防全麻后苏醒期躁动,效果明显优于曲马多,苏醒质量高,对呼吸、循环影响较小,可以安全用于预防全麻后苏醒期躁动.
Objective To explore the effects of fentanyl and tramadol on restlessness during consciousness phase after remifentanil-based general anesthesia. Methods 120 ASA II patients undergoing elective laparoscopic surgery under general anesthesia were randomly assigned to group Q1, Q2, Q3, F1, F2, or F3 with 20 each. 30 min before the end of the procedure, tramadol of 1, 2, or 3 mg/kg was administered to group Q1, Q2, or Q3. so was fentanyl of 0.1, 0.2, or 0.3 μ,/kg to groups F1, F2, and F3. SBP, DBP, MAP, HR, SpO2, and PftCO2 were recorded. Restlessness Score （RS）, Ramsay Sedation Score （RSS）, Observer＇s Assessment of Alertness/Sedation Score （OAAS） were recorded before, during, and 10 min after extubation. Body side reaction were observed. Results RS was apparently higher in groups Q1 and Q2 than in group Q3 before, （luring, and 10 min after extuhation （P〈0.05）. RS in group Q1 was apparently higher than that in groups F1, F2. and F3（P〈0.05）. RSS in groups Q1 and Q2 was apparently higher than that in group Q3 before, during, and 10 min after extuhation （{〈0.05）. RSS in groups Q1, Q2. and Q3 was apparently higher than that in groups F1, F2, and F3 （P〈0.05）. OASS in groups Q1 and Q2 was apparently higher than that in group Q3 before, during, and 10 min after extubation （P〈0.05）. OASS in group Q3 was apparently higher than that in groups F1, F2, and F3 （P〈0.05）. The major side effects in group F3 were respiratory depression and circulatory system. Conclusions Application of 0.3 μ g/kg fentany can safely and perfectly prevent restlessness during consciousness phase after remifentanil-based general anesthesia, and has fewer side effects.
出处
《国际医药卫生导报》
2010年第16期2004-2007,共4页
International Medicine and Health Guidance News
关键词
曲马多
芬太尼
苏醒期躁动
Fentanyl
Tramadol
Restlessness
Prevention
