曲马多超前镇痛对经肛门手术实施全凭静脉麻醉的影响

Pre-emptive analgesia with tramadol in patients undergoing anorectal surgery using total intravenous anesthesia

目的：观察曲马多超前镇痛用于全凭静脉麻醉下经肛门手术的麻醉安全性和术后镇痛的效果。方法：将60例ASAⅠ-Ⅱ级在全凭静脉麻醉下经肛门手术病例随机分成A、B两组,每组30例。A组芬太尼3μg/kg、丙泊芬2-3 mg/kg诱导,以丙泊酚6-10 mg.kg-1.h-1持续输注维持麻醉。B组诱导前静脉给予曲马多1.5-2 mg/kg,3-5 min后以芬太尼1.5μg/kg、丙泊芬2-3 mg/kg诱导麻醉,维持麻醉同A组。采用疼痛视觉模拟评分法（VAS）对患者出室前以及术后8 h内疼痛和镇静进行评分并记录恶心、呕吐等不良反应。结果：两组均顺利完成手术,A组麻醉后需用血管活性药物者9例,B组麻醉后需使用血管活性药物者1例,明显少于A组（P〈0.01）。B组出室前及术后6 h内镇痛效果优于A组,VAS显著低于A组（P〈0.05-P〈0.01）。结论：曲马多超前镇痛在经肛门手术静脉全麻中运用,术后6 h内具有较好的镇痛效果,可减少术中芬太尼的用量至1.5μg/kg,具有一定的临床价值。

Objective：To observe the effect and security of pre-emptive analgesia with tramadol in patients undergoing anorectal surgery by total intravenous anesthesia.Methods：Sixty patients in physical status Ⅰ-Ⅱas scored by American Society of Anesthesiologists（ASA）and undergoing anorectal surgery were randomly divided into two groups.Group A were induced with fentanyl 3 μg/kg and propofol 2-3 mg/kg,and were anesthetized with continuous infusion of propofol 6-10 mg·kg-1·h-1.Group B received an intravenous injection of tramadol 1.5-2 mg/kg 3 min before induction,and then were induced with fentanyl 1.5 μg/kg and propofol 2-3 mg/kg with the same maintenance as group A.The visual analogue scales（VAS） and side effects such as nausea and vomiting 6 hours after operation were observed.Results：The operation was successful in both groups.Nine patients in group A and one patient in group B resorted to drugs due to SpO2 decrease during anesthesia.The difference was significant（P0.01）.The VAS of group B was markedly lower and the effect of analgesia was better than that of group A 6 hours after operation（P0.05-P0.01）.Conclusions：Pre-emptive analgesia with tramadol for patients undergoing anorectal surgery using total intravenous anesthesia can provide satisfactory analgesic effect and reduce the dosage of fentanyl to 1.5 μg/kg,which may decrease the influence of SpO2 and mean arterial pressure during anesthesia.This technique has certain clinical value.