【摘要】 目的　观察曲马多术后持续静脉镇痛的作用效应及监测镇痛期间的曲马多血清浓度。方法　选择全身麻醉术后病人 5 0 0例 ,手术结束前缝深层组织时静注负荷剂量曲马多 1 5mg/kg ,随机分为两组 ,Ⅰ组 (n =2 4 6 )曲马多 6 0 0mg +氟哌啶醇 10mg ,加生理盐水稀释至 15 0ml,剂量为 8mg·h-1;Ⅱ组 (n =2 5 4 )曲马多 80 0mg +氟哌啶醇 10mg ,加生理盐水稀释至 16 0ml,剂量为 10mg·h-1。两组持续静输 72h。选择II组病人 10例 ,于镇痛期间 0、0 5、1、3、6、12、2 4、30、4 2、4 8、5 4、6 0、72h各采静脉血 3ml。观察指标 :镇痛效果 (VAS评分 )、不良反应及用高效液相色谱仪测定曲马多血清浓度。结果　Ⅰ组VAS为 1 16± 1 15 ,Ⅱ组为 0 83± 1 33,Ⅰ组镇痛效果满意率为 84 15 % ,Ⅱ组为91 33% ,两组比较差异显著 (P <0 0 1)。两组病人镇痛期间恶心、呕吐、嗜睡等不良反应发生率均无显著差异 ,但Ⅰ组尿潴留发生率 (6 2 5 % )较Ⅱ组 (10 6 % )低 (P <0 0 5 )。镇痛期间曲马多平均血药浓度为 (0 5 2 1± 0 2 16 ) μg/ml。 结论　曲马多 10mg·h-1连续静输用于手术后病人的镇痛 ,效果确切 ,不良反应较少 ;其血清治疗浓度约为 5 0 0ng/ml。更多还原

【Abstract】 Objective To examine pharmacodynamics and serum concentration of tramadol during continuous intravenous infusion for postoperative pain relief Methods 500 ASA Ⅰ Ⅱ patients undergoing operation on extremities, spine or abdomen under anesthesia were studied Premedication included phenobarbital 0 1g and atropine 0 5mg im Anesthesia was induced with midazolam 0 08 0 12mg·kg -1 , fentanyl 5 6μg·kg -1 and vecuronium 0 12 0 14 mg·kg -1 and maintained with continuous intravenous infusion of propofol 3 0 4 5 mg·kg -1 ·h -1 , fentanyl 2 8 3 4μg·kg -1 ·h -1 and vecuronium 0 06 0 08 mg·kg -1 ·h -1 supplemented with inhalation of 0 8% 1 0% isoflurane At the end of operation a loading dose of tramadol 1 5 mg·kg -1 was given intravenously over 2 min, followed by continuous intravenous infusion of tramadol for 72h The patients were divided into two groups: group Ⅰ (n=246) received tramadol intravenous infusion at a rate of 8mg h -1 and group Ⅱ (n=254) received tramadol infusion at a rate of 10mg h -1 Venous blood samples were taken from 10 patients in group Ⅱ at 0, 0 5, 1, 3, 6, 12, 24, 30, 42, 48, 54, 60, 72h during postoperative tramadol infusion for determination of serum concentration of tramadol by high performance liquid chromatography (HPLC) Efficacy of analgesia was assessed by VAS score and side effects were recorded Results The two groups were comparable with regard to age, sex, weight, types of operation and the amount of fentanyl used during operation There was significant difference in the mean VAS scores between group Ⅰ (1 16±1 15) and group Ⅱ (0 83±1 33) (P<0 01) The overall satisfaction rate was 84 15% in group Ⅰand 91 33% in group Ⅱ(P<0 01) However there was no significant difference in side effects such as nausea, vomiting and drowsiness between the two groups except the occurrence of urine retention which was more frequent in group Ⅱ (10 6%) than in group Ⅰ (6 25%) The mean serum concentration of tramadol during tramadol iv infusion at a rate of 10 mg·h -1 was (0 521±0 216)μg·ml -1 Couclusions Continuous intravenous infusion of tramadol 10 mg·h -1 can provide satisfactory postoperative pain relief with fewer side effects The therapeutic serum concentration of tramadol for postoperative analgesia is about 500ng·ml -1更多还原