曲马多抑制瑞芬太尼致术后痛觉过敏的量效关系

Dose-response relationship of tramadol for inhibiting postoperative hyperalgesia after remifentanil-based anesthesia

目的确定曲马多抑制瑞芬太尼致术后痛觉过敏的量效关系。方法选择60例ASAⅠ或Ⅱ级,20-60岁择期全麻腹腔镜下行胆囊切除术的成年患者,按所用曲马多的剂量(3.1,2.5,2.0,1.6,1.3,1.0 mg/kg)随机分为6组。于手术开始前给予规定剂量的曲马多。以丙泊酚和瑞芬太尼行全静脉麻醉,瑞芬太尼维持剂量为0.25μg/(kg.min),记录清醒拔管后15 minVAS评分(VAS<4分为抑制痛觉过敏有效),用Probit回归分析数据,得出曲马多抑制瑞芬太尼致术后痛觉过敏的ED50和ED95。结果曲马多抑制瑞芬太尼致术后痛觉过敏的ED50为1.66 mg/kg(95%可信区间:1.41-1.94 mg/kg),ED95为3.10 mg/kg(95%可信区间:2.47-5.59 mg/kg)。结论曲马多抑制瑞芬太尼致术后痛觉过敏的ED50和ED95分别为1.66mg/kg和3.10 mg/kg。

Objective To investigate the dose-response relationship of tramadol for inhibiting the postoperative hyperalgesia after remifentanil-based anesthesia.Methods Sixty ASAⅠorⅡ,20-60 year-old patients receiving laparoscopic cholecystectomy were randomly allocated into six tramadol dose groups（3.1,2.5,2.0,1.6,1.3,1.0 mg/kg）.All patients received tramadol before the beginning of the surgery.Propofol and remifentanil were used for the general anaesthesia.Remifentanil was infused at 0.25 μg/（kg · min）.Pain was assessed with VAS at 15 min after tracheal extubation（VAS4 was defined as effective）.A Probit analysis was performed to calculate the efficient doses of tramadol for inhibiting hyperalgesia in 50% and 95% of patients（ED50 and ED95）.Results The ED50 of tramadol was 1.66 mg/kg（95% CI 1.41-1.94 mg/kg） and ED95 was 3.10 mg/kg（95%CI 2.47-5.59 mg/kg）.Conclusion The ED50 and ED95 of tramadol for inhibiting the postoperative hyperalgesia after remifentanil-based anesthesia with 0.25 μg/（kg·min） of remifentanil in patients following laparoscopic cholecystectomy are 1.66 mg/kg and 3.10 mg/kg,respectively.