术前硬膜外注入曲马多对妇科手术中地氟醚使用的影响

Effect of preoperative epidural tramadol administration on desflurane requirements during gynecologic surgery

目的探讨术前硬膜外给予曲马多对维持妇科手术中BIS值为40～60的呼气末地氟醚浓度的影响。方法随机选取40个全麻下腹式子宫切除的女性病人,随机分为两组,盐水组(S组)和曲马多组(T组)。所有病人均在腰3、4节段硬外腔置管,在麻醉诱导前20min分别注入生理盐水10mL加或不加曲马多200mg。麻醉中采用地氟醚持续吸入麻醉维持,测量手术前及术中每隔10min的BIS值、呼气末地氟醚浓度、心率和无创血压作为指标。结果与盐水组相比,曲马多组的呼气末地氟醚浓度明显呈下降趋势,差别具有统计学意义,该组心率在各测量时也较盐水组慢(P<0.05),术中的BIS值差异无显著性。结论术前硬膜外注入曲马多可以减少全麻手术中地氟醚的用量。

[Objective] To investigate the effect of epidural tramadol on the end-tidal destlurane concentration titrated to maintain the bispeetal index （BIS）values between 40 and 60 during gynecologic surgery. [Methods] Forty patients undergoing transabdominal hysterectomy under general anesthesia were randomly and prospectively assigned to 1 of 2 study groups： saline group （group S） and tramadol group （group T）, After placing an epidural catheter at L3-4, patients were ehjeeted with either 10 mL of saline or 200rag of tramadol in 10 mL of saline approximately 20 minutes before anesthesia induction. Anesthesia maintenance was provided with desflurane by an anesthesiologist blinded to the group. Measurements included BIS value, end tidal desflurane Concentration, heart rate, and blood pressure before surgery and every 10 minutes during surgery. [Results] There was a tendency to slightly reduce end-tidal desflurane concentration in the tramadol group compared with saline group, this difference was statistical significant （P 〈0.05）. The heart rate was lower than in the saline group at any time of surgery （P 〈0.05）. BIS values were similar throughout surgery. [Conclusion] Preoperative administration of epidural tramadol injection reduce desflurane dosage in patients undergoing gynecologic surgery.