氟哌利多和曲马多预注在乳腺手术的超前镇痛效果观察

Effect of Droperidol and Tramadol on preemptive analgesia in breast operation

目的探讨氟哌利多和曲马多预防乳腺包块切除术后急性疼痛的效果。方法 60例ASAⅠ～Ⅱ级择期行乳腺包块切除术患者,分为A、B两组各30例。A组麻醉诱导后喉罩置入前静脉注射氟哌利多1 mg、曲马多3 mg/kg;B组手术结束前10～20min静脉注射氟哌利多1 mg、曲马多3 mg/kg。两组患者诱导用顺时阿曲库铵0.1 mg/kg、咪唑安定0.03 mg/kg、丙泊酚1～1.5 mg/kg、雷米芬太尼1μg/kg、地塞米松10 mg。意识消失后置入4#喉罩。麻醉维持以雷米芬太尼0.1～0.25μg/(kg.min)、丙泊酚5～8 mg/(kg.h)微量泵持续输注。在缝皮结束前2 min停麻醉药。记录患者完全清醒时和清醒后0.5、1、2、4、6、8 h的疼痛视觉模拟评分(VAS)评分及不良反应。结果术后0.5、1、2、4、6 h VAS评分A组明显低于B组(P<0.05),而8 h两组差异无统计学意义(P>0.05);不良反应的发生率A组低于B组(P<0.05)。结论 应用氟哌利多和曲马多预防乳腺包块切除术后急性疼痛,麻醉诱导后喉罩置入前用药效果优于手术结束前用药,提示氟哌利多和曲马多具有超前镇痛作用。

Objective To study the effect of Droperidol and Tramadol on postoperative analgesia in breast operation.Methods Sixty patients（ASA Ⅰ or Ⅱ） undergoing breast operation were randomly allocated to two groups,with 30 cases in each group.The patients in group A received Droperidol 1 mg and Tramadol 3 mg/kg before laryngeal mask insertion after induction of anesthesia,and those in group B received Droperidol 1mg and Tramadol 3 mg/kg 10~20 min before the end of operation.All the patients were induced with Cisatracurium 0.1 mg/kg,Midazolame 0.03 mg/kg,Propofol 1~1.5 mg/kg,Remifentanil 1 μg/kg and Dexamethasone 10 mg,then inserted laryngeal mask.Anesthesia was maintained with Remifentanil 0.1~0.25 μg/kg·min and Propofol 5~8 mg/（kg·h）.Postoperative pain was assessed by visual analogue scale（VAS）.Side effect was observed as well.Results The VAS was lower in group A than that in group B 0.5,1,2,4 and 6 h after operation（P0.05）.The difference was not significant 8 h after operation（P0.05）.The rate of side effect was lower in group A than that in group B（P0.05）.Conclusions Droperidol and Tramadol administered may relieve postoperative pain in patients undergoing breast operation.It is more effective to inject Droperidol and Tramadol before laryngeal mask insertion after induction of anesthesia than before the end of operation.