【摘要】 目的:探讨曲马多对于瑞芬太尼麻醉之后出现早期疼痛的临床预防效果。方法:90例在静脉麻醉联合喉罩下进行腹腔镜胆囊切除手术的患者,分为3组(每组30例),分别在手术近结束缝合皮肤的时候,行静脉注射曲马多2mg/Bg(A组),氯胺酮0.5mg/Bg(B组),生理盐水2mL(C组)。所有的患者均以丙泊酚、瑞芬太尼以及罗库溴铵进行麻醉诱导,手术中以丙泊酚、瑞芬太尼来维持麻醉,手术毕送入麻醉后恢复室。在患者出现了中等程度的疼痛(疼痛的视觉模拟评分(VAS)≥6分)的时候,给予曲马多2mg/Bg,并记录术后的苏醒时间、患者的喉罩拔除的时间、手术后镇痛药物的使用率、VAS评分、以及患者的各项生命体征、不良反应。患者苏醒之后30min内进行评分,以VAS≥6分为镇痛失败。结果:该3组患者在手术结束之后苏醒时间、患者喉罩拔除的时间及各时点的血压、心率比较差异均无显著性(P>0.05);在患者苏醒后的1min,10min,20min,0.5h,4h的VAS评分中,A组和B组均低于C组(P<0.05);在镇痛药物的使用率方面,A组和B组均低于C组(P<0.01),且A组低于B组(P=0.01);手术后患者的躁动率,A组和B组均显著的低于C组(P<0.01)。结论:曲马多对瑞芬太尼麻醉后的早期疼痛有着明显的预防性作用,与氯胺酮相比较,效应更强。更多还原

【Abstract】 Objective: To study the analgesic effect of tramadol hydrochloride on the patients undergoing laparoscopic cholecystectomy after remifentanil-based anaesthesia.Method: A total number of ninety ASA Ⅰ-Ⅱ adult patients who underwent the operation of laparoscopic cholecystectomy were divided into three groups randomly.Controlled group(Group C),Tramadol group(Group A)and ketamine group(Group B).Before the end of surgery,the patient of group A was given tramadol hydrochloride 2 mg/kg,group B was given ketamine 0.5 mg/kg,and group C was given 2mL 0.9% natural solution.All patients were inducted by using propofol,remifentanil and rocuronium,and maintained aneasthesia with propofol and remifentanil throughout the operation.In the recovery room,those patients were given tramadol 2mg/kg who felt the moderate pain(VAS score ≥6).VAS score,the time of requiring analgesia by patients and adverse drug reactions such as nausea,vomit and diplopia were recorded for 30min after surgery.Result: There were no significant differece in postoperation recovery time,pharyngeal mask withdrew time,heart rate and blood pressure changes amorg the three groups(P> 0.05).At the time of 1 min,10 min,20 min,0.5 hours and 4 hours after patients regaining consciousness,the VAS scores of group A and group B were significantly lower than that of group C(P <0.05),the frequency of patients requiring analgesia in group A and group B were also significantly lower than that in group C(P <0.01),and moreover group A were lower than group B(P = 0.01),the adverse drug reaction showed no significant difference except that the incidence of restlessness of group A and B were significantly lower than that in group C(P< 0.01).Conclusion: As well as ketamine,tramadol hydrochloride has significant analgesic effect on patients with postoperative hyperalgesia after remifentanil-based anaesthesia.更多还原