芬太尼复合曲马多用于瑞芬太尼全麻苏醒期的观察

Effect of fentanyl combined with tramadol during the recovering period from general anesthesia of remifentanil

目的观察芬太尼复合曲马多减轻瑞芬太尼全麻苏醒期疼痛的效果。方法选择妇科宫外孕和卵巢囊肿患者共90例，ASA分级Ⅰ-Ⅱ级，手术时间1．5h以内，随机分为T组、F组和T＋F组，术中以持续靶控输注丙泊酚和瑞芬太尼，间断给予维库溴铵维持麻醉。T组患者手术结束前30min给予曲马多2mg／kg，F组患者手术结束前10min给予芬太尼2肛∥kg。T＋F组手术结束前30min给予曲马多1．5mg／kg，手术结束前10min再给予芬太尼1肛g／kg，记录呼吸恢复时间、苏醒时间，警觉／镇静评分（OAA／S）、拔管后VAS评分和不良反应。结果三组患者手术结束后呼吸恢复时间、苏醒时间、OAA／S评分和瘙瘁、躁动比较差异均无统计学意义（P〉0．05），麻醉拔管后均无呼吸抑制、恶心、呕吐发生。拔管后T组、F组VAS评分比较差异无统计学意义（P〉0．05），T＋F组VAS评分和T、F组比较差异有统计学意义（P〈0．05）。结论预防瑞芬太尼全麻术后苏醒期疼痛，芬太尼复合曲马多较单一使用芬太尼或曲马多更有优势。

Objective To observe patients＇ pain after remifentanil anesthesia the effect of fentanyl combined during the recovering period with tramadol on alleviating Methods Total 90 patients with ectopic pregnancy and ovarian cyst, ASA Ⅰ -Ⅱ, operating time less than 1.5 hours. They were di- vided into 3 groups randomly, T Group, F Group, and T ＋ F Group, all patients were continuously given target controlled infusion of propofol and remifentanil, and discontinuously given vecuronium to maintain anesthesia. Each patient in T Group was given 2 mg/kg tramadol 30 minutes before the finish of surgery. Each patient in F Group was given 2μg/kg fentanyl 10 minutes before the finish of surgery. Each patient in T ＋ F Group was given 1.5 mg/kg tramadol 30 minutes before the finish of surgery and given 1 μg/kg fentanyl 10 minutes before the finish of surgery. Breathing recovery time, waking time, OAA/S, VAS grade after removing tube and side effects were recorded. Results There was no statistical difference in breathing recovery time, waking time, OAA/S, itching, or dysphoria after the finish of surgery among the three groups （ P 〉 0. 05）, No respiratory depression, nausea, or vomiting occurred after removing anesthesia tube among the three groups. There was no statistical difference on VAS grade between T Group and F Group after removing tube （ P 〉 0. 05）, and there were marked differences on VAS grade between T ＋ F Group and T Group, and between T ＋ F Group and F Group （ P 〈 0. 05）. Conclusions For preventing pain during the recovering period from general anesthesia of remifentanil, fentanyl combined with tramadol has more advantages than using single fentanyl or tramadol.