曲马多、哌替啶与恩丹西酮预处理对全麻恢复期寒战的影响

Effects of pretreatment with tramadol,pethidine and ondansetron on postoperative shivering

目的探讨不同药物预处理对全麻恢复期寒战的预防效果。方法80例妇科腹腔镜病人随机分为曲马多2.0mg/kg（T）组、哌替啶1.0mg/kg（P）组、恩丹西酮0.08mg/kg（O）组和生理盐水10mL（C）组,每组20例。常规全麻诱导,气管内插管,插管后各组分别静脉注射试验药物,以丙泊酚5～6mg/kg·h、瑞芬太尼0.20～0.25μg/kg·min及维库溴铵维持麻醉。术中监测血压、心率、体温,术后5、30、60min分别对寒战、镇静、疼痛进行评估,并观察不良反应的发生情况。结果T组术中体温降低幅度明显小于其他各组;T组与P组术后寒战发生率明显小于O、C组,T、P组间无明显差别;T组术后VAS疼痛评分明显小于其他各组;镇静评分各组无明显差别。结论曲马多预处理可以明显减轻全麻术后寒战。

Objective To investigate the effects of pretreatment with tramadol, pethidine and ondansetron on postoperative shivering. Methods Eighty patients with gynaecological laparoscopy were randomly divided into tramadol group, pethidine group, ondansetron group and normal saline group. With general anesthesia, tramadol （2.0 mg/kg）, pethidine （1.0 mg/kg）, ondansetron （0.08 mg/kg） and normal saline （10 mL） were respectively administered after endotracheal intubation. The anesthesia was maintained with propofol, remifentanyl and vecuronium. Signs and parameters such as body temprature were monitored during the operation, time of recovery was recorded, manifestations of shivering, analgesia and sedation were evaluated 5, 30 and 60 min after the entrance of PACU, and the side effects were observed. Results Compared with other groups, time of recovery was significantly longer in pethidine group. The variation of body temperature was significantly less in tramadol group than that in other groups. The incidence of postoperative shivering was much lower in tramadol group and pethidine group than in ondansetron group and normal saline group, while there was no significant difference between tramadol group and pethidine group. Tramadol group achieved significantly smaller VAS scores for analgesia than the other groups. There was no significant difference in Ramsay scores for sedation among the groups, and no severe side effects were observed. Conclusions Pretreatment with tramadol is effective in preventing postoperative shivering.