曲马多预防全麻复合硬膜外麻醉后寒战研究

Postanesthetic shivering under total anesthesia combined epidural anesthesia prevented by tramadol

目的探讨全麻复合硬膜外腹部手术关腹时静注曲马多预防麻醉术后寒战的有效性。方法选择90例ASAl～2级择期全麻复合硬膜外麻醉腹部手术成年患者,随机分为3组,Ⅰ组(对照组)0.9%生理盐水,Ⅱ组曲马多lmg/kg,Ⅲ组曲马多2mg/kg,均稀释到5ml关腹时静注。观察术后寒战分级,鼻咽体温,呼吸抑制,恶心呕吐、苏醒延迟。结果与对照组(13例)比较,2组(2例)和3组(1例)术后寒战发生率差别显著,P<0.01。体温变化情况,与麻醉前比较,术后各组体温显著降低,P<0.05;与对照组比较,2组与3组差别无统计学意义。术后苏醒延迟发生情况,对照组和3组之间差别显著,P<0.05。各组术后均未出现呼吸抑制。术后恶心呕吐发生率差别无统计学意义。结论关腹时静注曲马多可安全、有效地预防全麻复合硬膜外麻醉术后寒战。

Objective To study whether trarnadol administered at the time of wound closure can prevent postanesthetic shivering under total anesthesia combined epidural anesthesia. Methods 90 patient undergoing abdominal operation under total anesthesia combined epidural anesthesia were randomly assigned to group 1 （control,0.9% Sodium Chloride）, group 2 （tramadol lmg/kg） and group 3 （tramadol 2mg/kg）. Drugs were diluted to 5ml and administered intravenous at the time of wound closure. The incidence of shivering after operation,epipharynx temperature, respiratory depression, nausea and vomiting and awake delay were recorded. Results After operation,the incidence of shivering in control group （43.3%） is significantly higher than in group 2 （6.7%）and group 3 （3.3%）（P〈0.01）, epipharynx temperature is significantly lower than preanesthesia in every groups （P〈0.05） and the incidence of awake delay in group 3 （26.7%） is significantly higher than in control group （6.7%）. There was no respiratory depression in any of the groups.There were no significant differences in the incidence of nausea and vomiting among these groups. Conclusion Tramadol administered at the time of wound closure can safely and effectively prevent postanesthetic shivering under total anesthesia combined epidural anesthesia after abdominal operation.