局部麻醉联合应用曲马朵对颈部手术患者超前镇痛效果的评价

Evaluation of the effect of preemptive analgesia receiving tramadol combined with local anesthesia in neck surgery

目的:评估颈部手术前静脉应用曲马朵的超前镇痛效应. 方法:按美国麻醉学家学会(ASA)标准分级,将Ⅰ～Ⅱ级拟行颈部手术的80例患者随机分为两组,每组40例.P组为超前镇痛组(局部麻醉+曲马朵),C组为对照组(局部麻醉+等渗盐水).P组切皮前15min静脉给予曲马朵3mg/kg+盐酸格拉司琼40μg/kg,共10ml.C组切皮前15min静脉给予等渗盐水+盐酸格拉司琼40μg/kg,共10ml,术后均采用患者自控性镇痛法(PCA)止痛,观察并记录两组给药前、后5min、切皮、术中深部操作、缝皮时患者的血压、心率、视觉类同表(VAS)评分和术后2、4、8、16和24h的VAS评分,记录术后患者首次按压PCA时间、有效按压次数及术后镇痛药总用量. 结果:P组与C组比较,在0～24h内各时段VAS评分均显著降低(P<0.05);首次需要PCA时间P组明显晚于C组(P<0.01);PCA有效按压次数:P组患者在术后4、8和24h内明显少于C组(P<0.05);术后镇痛药累积用量P组明显少于C组(P<0.05). 结论:在颈部手术中,术前预先给予曲马朵可产生良好的超前镇痛效果.

Objective： To evaluate the preemptive analgesia of intravenous tramadol preoperatively in neck-surgery. Methods： Eighty patients, ASA Ⅰ-Ⅱ, were scheduled for neck-surgery under local anesthesia. Patients were randomly divided into 2 groups （40 eases/group）. In group P intravenous tramadol was administered as a bolus dose of 3 mg/kg 15 min prior to skin incision. Group C received saline as a placebo. The patients-controlled analgesia（PCA） devices were used in all patients after operation. We observed BP, HR,VAS score, the time of first PCA activation, the valid number of press PCA and the total consumption of analgesic after operation. Results：The postoperative VAS was markedly lower in group P compared with the group C in 0 - 24 h （ P 〈 0. 05 ）. The time of first PCA activation was significandy longer in group P than that in group C （P 〈 0. 01 ）. The total number of press PCA was obviously smaller in group P than that in group C within 4h,8h ,24h（P 〈0.05）. Markedly smaller consumption of analgesic after operation was found in group P than that in group C （ P 〈 0. 05 ）. Conclusion ： Intravenous tramadol may provide reliable preemptive analgesia following neck-surgery.