曲马多超前镇痛对无痛人流术后镇痛效果的影响

Preemptive analgesic effect of Tramadol injection in patients undergoing painless induced abortion

目的观察曲马多超前镇痛对无痛人流术后镇痛效果的影响。方法选择ASAⅠ～Ⅱ级,妊娠4～12周,拟行人流术的患者90例,分成曲马多复合丙泊酚组(A组)、芬太尼复合丙泊酚组(B组)及单纯丙泊酚组(C组),每组30例。A组先缓慢静注曲马多50mg,术中用丙泊酚镇静;B组先缓慢静注芬太尼50μg,5min后开始静注丙泊酚;C组单纯使用丙泊酚。3组患者丙泊酚的诱导量为2mg/kg,术中根据患者的躯体反应必要时追加诱导量的1/3～1/2。观察术前及术中血压(BP)、心率(HR)、脉搏氧饱和度(SPO2)、丙泊酚用量、清醒时间、术后恶心呕吐、下腹疼痛程度(采用VAS评分法)。结果3组术中BP、HR、SPO2、清醒时间、术后恶心呕吐比较差异无显著性(P>0.05);丙泊酚用量、术后下腹疼痛程度A组及B组明显低于C组(P<0.05)。结论曲马多超前镇痛用于无痛人流术,可显著减少丙泊酚用药量,显著减轻患者术后下腹疼痛程度而不增加不良反应。

[Objective] To evaluate the preemptive analgesic effect of Tramadol injection in patients undergoing painless induced abortion. [Methods] 90 female patients pregnant in 4-12 weeks （ASA Ⅰ-Ⅱ） undergoing painless abortion were divided randomly into three groups： Tramadol plus Propofol （group A, n =30）, Fentanyl plus Propofol （group B, n =30） and Propofol alone （group C, n =30）.Patients in group A were received Tramadol 50 mg by i.v. before injected with Propofol. by i.v, patients in group B were received Fentanyl 50 μg by i.v. after 5 min injected with propofol by i.v. patients in group C were only received Propofol by i.v. All the patients were given Propofol 2 mg/kg to induce general anesthesia, additional dosage of Propofol were given 1/3-1/2 of induced dosage according to the body reaction during operation.The blood pressure, heart rate and SPO2, total dosage of Propofol, perceptive time, postoperative nausea, pain intensity of lower abdominal and vomiting were measured and recorded at preoperatively and intraoperatively, （using the VAS score）. [Results] There was no statistically significance （P 〉0.05） in BP, HR, SPO2, perceptive time, postoperative nausea and vomiting inthree tested groups. The group A and B showed a significant decrease in the total dosage of Propofol and less pain intensity of lower abdominal by VAS compared with group C （P 〈0.05）. [Conclusion] Tramadol used in painless induced abortion can significantly decrease the total dosage of Propofol and the pain intensity of lower abdominal after operation without bad reaction.