曲马多术中给药时机对术后镇痛效果影响的探讨

Effect of the timing for intraoperative tramadol on postoperative analgesia

目的比较曲马多麻醉诱导后和手术结束前综合给药方案与单纯手术结束前给药对于开腹手术术中镇静程度，麻醉苏醒质量以及术后镇痛效果和副作用的影响，探讨适合开腹手术的曲马多术中应用方案。方法选择60例开腹手术患者，通过电脑生成的随机数字表将患者分为曲马多麻醉诱导后和手术结束前给药组（A组）以及曲马多手术结束前给药组（B组）。A组于气管插管后和手术结束前30min分别给予曲马多1．5mg／kg，B组仅手术结束前30min给予曲马多1．5mg／kg。记录并比较两组术中给予曲马多前后双频谱指数（bispectral index，BIS）值变化，麻醉苏醒，术后镇痛的视觉模拟评分（visualanalogue scale，VAS）和术后恶心呕吐（postoperative nausea and vomiting，PONV）、镇静评分、头晕等情况。结果两组患者一般情况差异无统计学意义。术中曲马多1．5mg／kg给药前后BIS值变化差异无统计学意义，两组患者麻醉苏醒和完全清醒时间以及相应BIS值差异无统计学意义（P〉0．05）。术后0．5、2,6、12hVAS评分，A组优于B组[不同时点VAS评分A组为（3．4±0．5）、（3．2±0．5）、（3．1±0．4）和（3，1±0．4）；组B为（3．9±0．6）、（3．6±0．6）、（3．4±0．6）和（3．4±0．5），P〈0．05或P〈0．01]；24h及48h两组差异无统计学意义。术后镇静评分，补救用药，有无PONV，头晕等情况两组差异无统计学意义。结论麻醉诱导后和手术结束前联合应用曲马多较单纯手术结束前应用曲马多有助于改善术后0．5h-12h镇痛效果，且未增加副作用。

Objective To compare the anesthesic depth, postoperative analgesia and side-effects between patients who received double doses of intraoperative tramadol when on induction and near the end of the operation, and those who received single dose of tramadol only near the end of the operation. Methods Sixty patients undergoing laparotomy were involved in this study and randomly divided into 2 groups by using a computer-generated random number table. The patiens in group A received 1.5 mg/kg tramadol for twice when on induction and 30 min before the end of the operation. And the patiens in group B received a single dose of 1.5 mg/kg tramadol 30 min before the end of the operation, bispectral index （BIS） was recorded before and after tramadol administration. The recovery from anesthesia, visual analogue scale（VAS） and side-effects of postoperative analgesia were monitored. Results There was no difference in the baseline characteristics between two groups. BIS were comparable before and after tramadol administration in both groups（P〉O.05）. VAS was significantly lower in group A than in group B at the time of postoperative 0.5, 2, 6 h and 12 h, respectively （VAS 3.4±0.5,3.2±0.5,3.1±0.4 and 3.1±0.4 in group A vs 3.9±0.6,3.6±0.6,3.4±0.6 and 3.4±0.5 in group B correspondingly, P〈0.05 or P〈0.01）, while there was no difference at the time of postoperative 24 h or 48 h. Ramsay scores, incidence of postopertive nausea and vomiting （PONV）, dizziness, and supplemental analgesics did not show different between groups. Conclusions The double-dose protocol of intraoperative tramadol administered when on induction and near the end of the operation showed better postoperative analgesia without increasing the side-effects in the first postoperative 12 h.