【摘要】 目的　研究曲马多术后静脉镇痛时血清治疗浓度。方法　 2 0例上腹部手术成年病人 ,ASAⅠ～Ⅱ级 ,术后静注曲马多镇痛 ,当病人感到轻微疼痛时 (VAS 1～ 2分 ) ,予初始量 1 5mg/kg ,再次感到疼痛时 (VAS 1～ 2分 ) ,追加 2 0mg静注 ,直至VAS 0分。观察 2 4h。每次追加剂量前采取血样3ml,用高效液相法测定血清药物浓度。同时记录静注曲马多起效时间 (用药毕至VAS 0分 )及作用持续时间 (VAS 0分至VAS1～ 2分 ) ,总药量为初始量 2倍的时间 ,用药前、后 10、2 0及 30min时HR、MAP、RR及SaO2 。结果　曲马多术后静脉镇痛时平均血清治疗浓度为 370ng/ml(2 4 8 6～ 6 15 7)。初始剂量起效时间平均为 (9 2± 2 1)min。初始剂量作用持续时间为 (2 3± 1 0 )h。用药量达初始量2倍时的时间为 (6 4± 2 7)h。结论　曲马多用于术后镇痛安全有效 ,其血清治疗浓度波动范围大 ,要根据不同情况调整剂量。更多还原

【Abstract】 Objective To investigate the serum therapeutic concentration of tramadol during intravenous analgesia for postoperative pain relief Methods Twenty adult patients ASAⅠ Ⅱ (10 male,10 female) undergoing elective radical operation for cancer of stomach were treated with intravenous tramadol for postoperative pain relief Patients addicted to any drug or tolerant to opioid and patients with epilepsy or liver and/or renal dysfunction were excluded All patients were premedicated with intramuscular phenobarbital 0 1g and atropine 0 5mg Anesthesia was induced with midazolam 0 1mg/kg and fentanyl 5 μg/kg and intubation was facilitated with vecuronium 0 16mg/kg Anesthesia was maintained with continuous intravenous infusion of propofol 4 6 mg·kg -1 ·h -1 ,fentanyl 2 3 μg·kg -1 ·h -1 and vecuronium 0 1mg·kg -1 ·h -1 combined with inhalation of 1% isoflurane After surgery in ICU when patients felt slight pain (VAS 1 2), intravenous tramadol 1 5mg/kg was given as initial dose Whenever patients felt slight pain (VAS 1 2) again, a bolus of tramadol 20 mg was given intravenously every 10 min until VAS was 0 The onset time (from the end of iv injection of initial dose of tramadol to VAS 0), the duration of action (from VAS 0 to VAS 1 2) and the time when accumulated dose of tramadol amounted to twice the initial dose were recorded HR, MAP, respiratory rate (RR) and SpO 2 were monitored and recorded before and 10,20,30 min after administration of tramadol Venous blood samples were taken before each additional tramadol administration on demand for determination of serum tramadol concentration by high performance liquid chromatography Results The mean serum therapeutic level of tramadol during period of analgesia was (370±148)ng/ml(248 6 615 7ng/ml) The mean onset time of the initial dose was (9 2±2 1)min The mean duration of action was (2 3±1 0)h The time when accumulated dose of tramadol amounted to twice the initial dose was (6 4±2 7)h on average There were no significant changes in HR,MAP,RR and SpO 2 after tramadol Conclusions It is safe and effective to give intravenous tramadol for postoperative pain relief Serum therapeutic concentration of tramadol varies greatly from patient to patient, so the dose of tramadol should be individulized更多还原