国际麻醉学与复苏杂志   2012, Issue (1): 0-0
    
曲马多术中给药对麻醉深度及术后镇痛效果影响的探讨
张忱, 吴奇伟, 柳娟, 岳云1()
1.北京朝阳医院麻醉科
Effect of intraoperative tramadol on the depth of anesthesia and postoperative analgesia
 全文:
摘要:

目的:比较曲马多麻醉诱导后和手术结束前综合给药方案与单纯手术结束前给药对于开腹手术术中镇静程度,麻醉苏醒质量以及术后镇痛效果和副作用的影响。探讨适合开腹手术的曲马多术中应用方案。方法:选择60例开腹手术患者,随机分为曲马多麻醉诱导后和手术结束前给药组(组A)以及曲马多手术结束前给药组(组B)。组A于气管插管后和手术结束前30分钟分别给予曲马多1.5 mg.kg-1,组B仅手术结束前30分钟给予曲马多1.5 mg.kg-1。记录并比较两组术中给予曲马多前后BIS值变化,麻醉苏醒,术后镇痛的VAS评分和PONV、镇静评分、头晕等情况。结果:两组患者一般情况无显著差异。术中曲马多1.5 mg.kg-1给药前后BIS值无显著变化,两组病人麻醉苏醒和完全清醒时间以及相应BIS值无统计学差异(P>0.05)。术后0.5 h、2h、6h、12h VAS评分,组A优于组B(P<0.05或P<0.01);24h及48h两组无显著差异。术后镇静评分,补救用药,有无PONV,头晕等情况两组无显著差异。结论:麻醉诱导后和手术结束前联合应用曲马多较单纯手术结束前应用曲马多有助于改善术后0.5~12小时内镇痛效果,且未增加副作用。

关键词: 曲马多;超前镇痛;双频谱指数
Abstract:

Objective to compare the depth of anesthesia; the effects and side-effects of postoperative analgesia between patients who received intraoperative tramadol both before the start and end of the operation and those who received intraoperative tramadol before the end of the operation. Methods 60 patients undergoing open-abdominal surgery were involved in this study. The patients were randomly divided into 2 groups: patiens received 1.5 mg.kg-1 tramadol both before the start and 30 minutes before the end of the operation (group A) and patiens received 1.5 mg.kg-1 tramadol 30 minutes before the end of the operation (group B). BIS values were recored before and after tramadol administered; anesthesia recovery and VAS values and side-effects of postoperative analgesia were monitered. Results BIS values were comparable before and after tramadol administered in both groups(P>0.05). VAS were significantly lower in group A than in group B during 0.5h~12h after operation(P<0.05 or P<0.01). Ramsay scores, incidence of PONV, dizziness, and supplemental analgesics did not show differences between groups. Conclusion 1.5 mg.kg-1 tramadol administered both before the start and the end of the operation showed better postoperative analgesic effect without increasing side-effects.

Key words: Tramadol; Pre-emptive analgesia; Bispectral index