曲马多与芬太尼对全麻苏醒期镇痛效果的研究

Effects of Tramadol and Fentanyl on Analgesia in the Early Recovery Period after General Anesthesia

目的探讨术中应用曲马多、芬太尼对全麻苏醒期镇痛效果的影响。方法 2009年10月2010年4月将80例静脉麻醉下行胃癌根治术的患者随机分为4组:Q1组曲马多1mg/kg、F1组芬太尼1μg/kg、Q2组曲马多2mg/kg、F2组芬太尼2μg/kg。各组分别于术毕前30min静注给药。手术结束后送恢复室,比较4组的呼唤睁眼时间、拔管时间、拔管后即刻疼痛评分(VAS评分)、术前术后平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)的变化以及不良反应的发生情况。结果 4组患者呼唤睁眼时间差异无统计学意义(P>0.05),F2组的拔管时间明显长于其他3组(P<0.05),Q1组和F1组的疼痛评分明显高于Q2组和F2组(P<0.05),在T2时点,Q2组和F2组的MAP值明显低于Q1组和F1组(P<0.05)。结论曲马多2mg/kg与芬太尼2μg/kg的镇痛效果的效果相当,但安全性更高,更加适合全麻苏醒期的镇痛治疗。

Objective To investigate the effects of tramadol and fentanyl on analgesia in the early recovery period after general anesthesia. Methods A total of 80 patients who underwent the operation of gastric cancer under general anesthesia from October 2009 to April 2010 were randomly divided into four groups： group Q1 received tramadol 1 mg/kg, group F1 received fentanyl 1 μg/kg, group Q2 received tramadol 2 mg/kg, and group F2 received fentanyl 2 μg/kg. Thirty minutes before the end of surgery, intravenous administration was performed on all of the patients. In the recovery room, the wake-up time, extubation time, pain level evaluated by Visual Analogue Scale （VAS）, the mean arterial pressure （MAP）, heart rate （HR） and pulse oxygen saturation （SpO2） before and after the surgery, and incidence of complications were recorded. Results No significant differences in wake-up time among the four groups were found （P0.05）. The extubation time was longer in group F2 than that in the other three groups （P0.05）. The VAS scores in group Q1 and F1 were higher than those in group Q2 and F2. At the T2 time point, MAP in group Q2 and F2 were lower than those in group Q1 and F1 （P0.05）. Conclusion The analgesic efficacy of tramadol 2 mg/kg is similar to that of fentanyl 2 μg/kg, but tramadol is more suitable for analgesic treatment in recovery period after general anesthesia due to the higher security.