曲马多与氯胺酮预防雷米芬太尼麻醉颅脑手术患者术后痛觉过敏效果的比较被引量：1

Comparison of preventive effects of tramadol and ketamine on hyperalgesia after neurosurgical anesthesia

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摘要目的比较曲马多和氯胺酮预防雷米芬太尼麻醉颅脑手术患者术后痛觉过敏的效果。方法行颅脑幕上肿瘤切除术患者150例，按随机数字表法分为曲马多组、氯胺酮组和对照组，每组50例。麻醉维持采用雷米芬太尼0．1～0．2仙g／（kg·min）和丙泊酚，吸入七氟烷。缝皮前分别静脉注射曲马多1．5mg／kg、氯胺酮0．5mg／kg或0．9％氯化钠。记录患者苏醒时间、拔管时间、应用曲马多镇痛例数、曲马多用量及不良事件等。分别于苏醒后15、30、60、120min行视觉模拟评分（VAS）、Ramsay镇静评分。结果曲马多组、氯胺酮组应用曲马多镇痛例数和曲马多用量少于对照组（P〈0．01或〈0．05），曲马多组发生寒战例数少于对照组（P〈0．05）。曲马多组苏醒后15、30min，氯胺酮组苏醒后30min的VAS低于对照组（P〈0．05）；氯胺酮组苏醒后15minRamsay镇静评分[（2．9±0．6）分]高于曲马多组[（2．3±0．7）分]和对照组[（2．3±0．9）分]（P〈0．01）。结论曲马多和氯胺酮用于雷米芬太尼麻醉颅脑手术患者均可预防术后痛觉过敏，曲马多效果更佳。 Objective To compare the preventive effects of tramadol and ketamine on the patients with postoperative hyperalgesia after remifentanil-induced neurosurgical anesthesia. Methods One hundred and fifty patients undergoing craniotomy were assigned to tramadol group, ketamine group and normal saline group with 50 cases each by random digits table. Anesthesia was maintained with infusion of remifentanil [0.1-0.2 μg/（kg·min） ],propofol and sevoflurane. Tramadol（ 1.5 mg/kg）,ketamine（0.5 mg/kg） or normal saline was given before skin closing. The emergence time, trachea extubation time, patients required analgesia and tramadol consumption, reverse effect were recorded. The visual analog scale （VAS）, Ramsay scores at 15,30,60,120 minutes after emergence were performed. Results Patients required analgesia and tramadol consumption in tramadol group and ketamine group were significantly lower than those in normal saline group （P 〈 0.01 or 〈 0.05 ）. The occurrence of shiver in tramadol group was lower than that in normal saline group （P 〈0.05）. VAS scores in tramadol group at 15,30 minutes and in ketamine group at 30 minutes after emergence were significantly lower than those in normal saline group （P 〈 0.05）. Ramsay score in ketamine group at 15 minutes after emergence was higher than that in tramadol group and normal saline group [ （2.9 ±0.6） scores vs. （2.3±0.7） scores and （2.3 ± 0.9） scores ] （P 〈 0.01 ）. Conclusion Tramadol has a good preventive effect for postoperative hyperalgesia induced by remifentanil in neurosurgery compared with ketamine.

作者王会文张雪梅侯春梅韩如泉

机构地区首都医科大学附属北京天坛医院麻醉科

出处《中国医师进修杂志》 2011年第33期1-4,共4页 Chinese Journal of Postgraduates of Medicine

关键词曲马朵氯胺酮痛觉过敏神经外科手术 Tramadol Ketamine Hyperalgesia Neurosurgical procedures

分类号 R614 [医药卫生—麻醉学]

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参考文献12

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