乳癌根治术后静脉自控镇痛曲马多的最佳负荷剂量

Tramadol 2.5mg·kg^(-1) Appears to Be the Optimal Intraoperative Loading Dose before Patient-controlled Analgesia

目的 寻求乳癌根治术后静脉自控镇痛曲马多的最佳负荷剂量。方法 80例ASAⅠ～Ⅱ级女性乳癌病人 ,每组 2 0例 ,随机分为Ⅰ～Ⅳ组。各组分别在手术结束前 30min ,静脉注射曲马多负荷剂量1.2 5mg/kg、2 .5mg/kg、3.75mg/kg、5mg/kg。观察各组患者在PACU中疼痛、恶心、呕吐、镇静的发生情况。结果 在PACU中 ,为达到基础VAS评分≤ 3,Ⅰ组使用曲马多高达 8.8± 2 .91ml;95 % (19/ 2 0 )得使用PCA。Ⅲ组有 1例患者 (37min)、Ⅳ组有 2例患者 (39min、6 2min)发生苏醒延迟。Ⅲ组和Ⅳ组患者 2级镇静发生率分别为 30 %和 35 % (P <0 .0 5 )。结论 曲马多用于乳癌根治术后自控镇痛效果满意 ,手术结束前 30min 2 .5mg/kg曲马多的静脉负荷剂量具有与 3.75mg/kg和 5mg/kg等同的镇痛效果 。

Objective To identify the most appropriate inital dose to improve the quality of tramadol PCA.Methods During general anesthesia,80 patients undergoing radical operation of mastocarcinoma were randomly allocated to receive 1.25 mg/kg (Group Ⅰ), 2.5 mg/kg(Group Ⅱ), 3.75 mg/kg (Group Ⅲ),5mg/kg(Group Ⅳ) tramadol.The titration of additional tramadol by PCA every five minutes was performed in the postanesthesia care unit (PACU) until the visual analogue scale (VAS) score was≤3.An investigator blinded to study group recorded the VAS and side effects every ten minutes.Results In the PACU,significantly more tramadol ( 8.8 ± 2.9 vs 4.6 ± 2.3 , 2.0 ± 1.5 , 0.5 ± 0.4 , P < 0.05 ),and a higher incidence (19/20 vs 6/20,4/20,3/20, P < 0.05 ) of PCA use was observed in Group I compared to Groups Ⅱ-Ⅳ.VAS was significantly higher in Group I than in Groups Ⅱ-Ⅳ at zero and ten minutes ( P < 0.05 ).Unexpected delayed emergence anesthesia (>min) was observed in Group Ⅲ ( n =1) and in Group Ⅳ( n =2).Sedation was more important in Groups Ⅲ and Ⅳ than in Groups Ⅰ and Ⅱ( P < 0.05 ).Conclusion When considering efficacy and side-efect profile, 2.5 mg·kg -1 of tramadol is the optimal intraoperative dose of this drug to provid effective postoperative analgesia with minimal sedation.