曲马多超前镇痛对妇科腹腔镜手术术后疼痛影响的前瞻性随机对照研究

Effect of Preemptive Analgesia with Tramadol on Postoperative Pain in Patients Undergone Gynecological Laparoscopy:A Prospective Randomized Controlled Study

目的观察曲马多超前镇痛在妇科腹腔镜手术中的有效性及安全性。方法 2010年1月~6月,选择60例ASAⅠ~Ⅱ级全麻下行妇科腹腔镜手术病例,采用随机数字表法分为2组,每组30例。手术切皮前5 min实验组静注曲马多1.5 mg/kg,对照组静注生理盐水2 ml。观察术后苏醒时间,随访24 h VAS疼痛评分及Ram say镇静评分,镇痛药使用情况及不良反应发生情况等。结果 2组麻醉苏醒时间差异无显著性（P〉0.05）。与对照组相比,实验组术后12 h内VAS评分显著降低[术后1 h 1.50±1.76 vs.4.03±2.50,t=4.544,P=0.000;术后2 h 1.77±1.87 vs.4.47±2.67,t=4.532,P=0.000;术后4 h 1.63±1.40 vs.3.20±2.00,t=3.506,P=0.001;术后8 h 1.83±1.76 vs.2.80±1.85,t=2.074,P=0.043;术后12 h1.50±1.25 vs.2.30±1.66,t=2.104,P=0.040],术后镇痛药的应用明显减少（1例vs.7例,2χ=5.192,P=0.023）,副反应中仅头晕的发生例数较多（6例vs.1例,2χ=4.043,P=0.044）。2组Ram say镇静评分均为1~2分。结论妇科腹腔镜全麻术前静注曲马多1.5 mg/kg可有效缓解术后疼痛,减少辅助镇痛药用量,副作用较少,是临床上较好的镇痛方法。

Objective To observe the efficacy and safety of tramadol in preemptive analgesia for patients undergone gynecologic laparoscopy. Methods From January to June 2010,60 patients（ASA grade Ⅰ-Ⅱ） underwent gynecological laparoscopy under general anesthesia in our hospital.The patients were randomly divided into experiment and control groups with 30 cases in each.Five minutes before the operation,the experiment group received tramadol intravenously（1.5 mg/kg）,while the control group received normal saline（2 ml）.The postoperative recovery time,and VAS pain score and Ramsay sedation score,as well as the use of analgesia and its side effects,were monitored for 24 hours after the operation. Results No significant difference was observed between the two groups in postoperative recovery time（P0.05）.Compared with the control group,the experiment group showed significantly decreased VAS in 12 hours after the operation（1 hour： 1.50±1.76 vs.4.03±2.50,t=4.544,P=0.000;2 hours： 1.77±1.87 vs.4.47±2.67,t=4.532,P=0.000;4 hours： 1.63±1.40 vs.3.20±2.00,t=3.506,P=0.001;8 hours： 1.83±1.76 vs.2.80±1.85,t=2.074,P=0.043;12 hours： 1.50±1.25 vs.2.30±1.66,t=2.104,P=0.040）,and less use of analgesia（1 case vs.7 cases,χ2=5.192,P=0.023） with less cases of side effects but dizziness（6 cases vs.1 case,χ2=4.043,P=0.044）.The Ramsay sedation score was 1-2 in both the groups. Conclusions Preemptive intravenous administration of tramadol（1.5 mg/kg） can effectively reduce postoperative pain and the amount of supplementary of analgesia with less side effects.