盐酸曲马多与丁丙诺啡抑制气管拔管期应激反应比较

Comparison on the effects of tramadol and buprenorphine on reducing stress response from tracheal extubation

目的观察并比较盐酸曲马多与盐酸丁丙诺啡对全身麻醉苏醒拔管期机体应激反应的影响。方法90例ASAⅠ～Ⅱ级择期全麻下开腹手术患者,随机分为三组,每组30例。对照组(C组)缝皮前注射生理盐水5ml;盐酸曲马多组(T100)缝皮前静脉注射盐酸曲马多100mg;盐酸丁丙诺啡(buprenorphine)组(B0.15)缝皮前静脉注射盐酸丁丙诺啡0.15mg。所有患者均给予异丙酚、维库溴胺、芬太尼作为全麻诱导用药,气管插管后及手术中微泵持续静脉注射异丙酚,间断静脉注射维库溴胺维持全麻及肌松。分别于术前、拔管时和拔管后5min测量血压、心率和呼吸及血氧饱和度;并对患者清醒程度、血压、呼吸、肢体运动进行评估。记录拔管时躁动的发生率及清醒时间拔管时间。结果C组血液动力学受影响较大,拔管时SBP和HR与术前比较有非常显著升高(P<0.01),应激反应较大;T100组和B0.15组血液动力学较平稳,SBP、HR和SpO2与术前比较无显著差异(P>0.05),应激反应较小。拔管后5min各组各项指标基本恢复到术前水平。结论盐酸曲马多和盐酸丁丙诺啡都能减轻全身麻醉苏醒拔管期机体应激反应,而且不良反应小。

Objective To observe the effects of intravenous tramadol or buprenorphine on reducing stress response from tracheal extubation. Methods The 90 cases of ASA I-II patients, which were scheduled for selective surgery of abdomen were randomly divided into three groups and received a standard general anesthesia consisting of fentanyl, propofol, vereuronium and isoflurane. After the operation, tramadoll00mg （GroupT100）, buprenorphine 0.15mgkg （Group B0.15）,the normal saline （Group C） were given respectively by I.V. injection, postoperative tracheal extubation was performed when acceptable criteria was achieved. Non-invasive arterial pressure （SBP）,heart rate （HR） and SpO2 were recorded before operation, when tracheal extubation and after extubation 5min. Results Group C was more increased than before operative in SBP,HR when extubation （P〈0.01）; In groupT100 and group B0.15, SBP, HR and SpO2 were no variation significantly（P〉0.O5）.In groupC, T100 and B0.15, all the parameter were no variation significantly than before operative after extubation 5 minutes （P〉0.05）. Conclusion Intravenous tramadol and buprenorphine can all effectively relieve stress response from tracheal extubation.