曲马多和哌替啶预防硬膜外麻醉后寒战反应的对比观察

Effects of tramadol and pethidine on control of shivering during operation under epidural anesthesia

目的 观察曲马多和哌替啶预防硬膜外麻醉期间寒战反应的临床表现。方法 选择1 2 0例准备在硬膜外麻醉下行下腹部、下肢或脊柱手术的成年患者,随机分为3组:A组(曲马多组) ,B组(哌替啶组) ,C组(对照组)。三组均于硬膜外注药前30分钟分别肌注:曲马多1 .5 mg/kg(A组) ,氟哌啶5 mg(B组) ,同等容量的生理盐水(C组)。观察麻醉及手术过程中寒战的发生率,寒战的严重程度及术前、术中、术后的体温、平均动脉压(MAP)、心率(HR)、血氧饱和度(SPO2 )的变化。结果 A组、B组、C组寒战发生率为5 .0 %,1 0 .0 %和30 .0 %;C组分别与A、B组比较,差异有统计学意义(P<0 .0 1 ) ;3组患者术前、术中、术后的体温、MAP、HR、SPO2组间和组内对比,差异均无统计学意义(P>0 .0 5 ) ;不良反应发生率,B组较高,与A、C组比较,差异有统计学意义(P<0 .0 1 )。结论 硬膜外注药前肌注曲马多和哌替啶有助于预防硬膜外麻醉后寒战反应,其中曲马多的效果优于哌替啶。

Objective To observe the effects of tramadol and pethidine on control of shivering during surgical operations under epidural anesthesia. Methods 120 adult patients who were to undergo surgical operation on lower abdomen, lower limbs or spine were randomly divided into 3 groups: Group A, in which patients received intramuscular injection of tramadol(1.5 mg/kg) 30 minutes before epidural anesthesia; Group B, pethidine (5 mg) given at the same time point; and Group C, normal saline of the same volume. The incidence rate of shivering during operation was observed and body temperature, mean arterial pressure(MAP), heart rate (HR) and arterial oxygen saturation (SPO 2) were determined before, during and after operation. Results The incidence rate of shivering was 5.0%, 10.0% and 30.0% in three groups, respectively, and there was statistically significant difference between Group C and Group A or B (P<0.01). No differences were found in body temperature, MAP, HR, and SPO 2 before, during or after operation within each group or between groups(P>0.05). Patients in Group B had more side effects than the others(P<0.01). Conclusion Intramuscular injection of tramadol or pethidine before epidural is effective to control shivering, in which tramadol has a better result than pethidine.