曲马多预镇痛复合丙泊酚用于人工流产手术的临床观察

Clinical observations on tramadol preemptive analgesia combined with propofol in artificial abortion

目的研究曲马多预镇痛复合丙泊酚对人工流产手术麻醉和镇痛的影响。方法将289例美国麻醉医师协会(ASA)分级为Ⅰ～Ⅱ级的早孕患者分为3组:A组103例,麻醉前、手术完毕前均静脉注射0．9％氯化钠溶液2 mL;B组91例,麻醉前5 min静脉注射曲马多1 mg／kg,手术完毕前静脉注射0．9％氯化钠溶液2 mL; C组95例,麻醉前5 min静脉注射0．9％氯化钠溶液2 mL,手术完毕前静脉注射曲马多1 mg／kg。记录丙泊酚用量、疼痛评分、意识消失时间、手术持续时间和清醒时间以及麻醉前和麻醉后1、2、4 min的血压、心率和呼吸次数。结果麻醉后1 min,B组收缩压下降幅度明显低于A、C组(P值均<0．01),呼吸频率减少次数明显少于A、C组(P值均<0．01)。麻醉后4 min,B组收缩压回升幅度明显高于A、C组(P值均<0．01)。B组丙泊酚总用量明显少于A、C组(P值均<0．01)。B组清醒后首次和离院前二次数字量表(VNS)评分均明显低于A、C组(P值分别<0．01、0．05)。结论麻醉前静脉注射曲马多预镇痛复合丙泊酚用于人工流产手术,可显著减少丙泊酚用量,且麻醉平稳,术中、术后镇痛效果良好。

Objective To study the tramadol preemptive analgesia combined with propofol on anesthesia and pain-relief in artificial abortion. Methods Two hundred and eighty-nine early pregnancy patients （ASA Ⅰ～Ⅱ ） were divided into three groups in a double-blined, randomized manner. Trarnadol 1 mg/kg （group B, n = 91） was injected intravenously 5 min before anaesthesia and followed by 0.9% sodium chloride 2 mL intravenously before the end of operation. Two mL 0.9% NaC1 was injected alternatively before anesthesia and end of the operation in group A （n = 103）. Two mL 0.9% NaC1 was given intravenously 5 min before anesthesia and tramadol 1 mg/kg in the same way before the end of operation in group C （n = 95）. Blood pressure （BP）, heart rate （HR）, respiratory rate （RR）, electrocardiogram （ECG） and saturation of oxygen （SpO2） were recorded before and 1, 2, 4 rain after anaesthesia, as well as the dosages of propofol, time of disappearance of consciousness, recovery time and verbal number scale （VNS）. Results The decrease of systolic pressure and respiratory rate in group B were obviously less than those in group A or C （P 〈 0.01 for both）, 1 min after the anaesthesia. The increase of systolic pressure back in group B was higher than that in group A or C （P 〈 0.01 for both） 4 mins after anaesthesia. The dosage of propofol for group B was conspicuously less than that in group A or C （P 〈 0.01 for both）. VNS after recovery in group B was significantly less than that in group A or C （P 〈 0.01 for both）. VNS before leaving the hospital in group B was also less than that in group A or C （P 〈 0.01, 0.05, respectively）. Conclusion The tramadol preemptive analgesia combined propofol before anaesthesia for patients with artificial abortion, can significantly reduce the dosage of propofol, stabilize the anesthesia and produce a longer postoperative analgesia.