低剂量纳洛酮对曲马多镇痛效应的影响

The effect of low-dose naloxone on analgesia of tramadol

目的探讨低剂量的纳洛酮对曲马多镇痛效应的影响。方法择期在全麻下行经腹全子宫切除术患者80例,随机分为4组,所有的患者在手术结束前30min静脉注射2mg/kg曲马多负荷量,术后行患者自控静脉镇痛(PCIA)。镇痛药物选择曲马多20mg/kg,Ⅰ组不用纳洛酮(n=20),Ⅱ组纳洛酮2.4μg/kg(n=20),Ⅲ组纳洛酮4.8μg/kg(n=20),Ⅳ纳洛酮9.6μg/kg(n=20),稀释成100ml。PCA泵输注速度2ml/h,锁定时间15min。通过双盲方法分别于使用PCIA后1、6、12、24h使用视觉模拟评分(VAS)评估疼痛评分,记录恶心、呕吐评分、镇静评分、不良反应等。结果 75例患者参与这项研究,这些患者中曲马多静脉镇痛均提供了满意的镇痛效果。与对照组比较,纳洛酮组VAS评分差异无统计学意义,Ⅱ、Ⅲ、Ⅳ组在6h、12h和24h的镇静评分更低,P<0.05,恶心、呕吐评分在1、6、12、24h较对照组更低,P<0.05。而不同剂量纳洛酮组之间差异无统计学意义。结论低剂量的纳洛酮可以缓解曲马多引起的不良反应,而对其镇痛效应影响不明显。

Objective To explore the effect of low-dose naloxone on analgesia of tramadol.Methods Eighty patients undergoing general anesthesia for elective total abdominal hysterectomy were randomly divided into four groups.All patients received 2mg/kg tramadol 30 minutes before the end of surgery,followed by a continuous infusion with 20mg/kg tramadol with no naloxone（groupⅠn=20）,2.4μg/kg naloxone（groupⅡn=20）,4.8μg/kg naloxone（group Ⅲ n=20）,9.6μg/kg（group Ⅳ n=20）,diluted to 100ml.Pain assessments were recorded one hour after starting the PCIA and then at 6、12 and 24 hours by using visual analogue scale（VAS）.Nausea Vomiting score,sedation score and side effect were also recorded.Results Seventy-five patients were included in this study.The intravenous tramadol administration provided the satisfied analgesia.There was no significant difference in VAS scores among naloxone groups and control group,compared with control group,sedation was less in group Ⅱ Ⅲ and Ⅳ at 6,12 and 24 hours,P〈0.05.The incidence of nausea vomiting in the naloxone group was lower than control group,P〈0.05.Conclusion A small-dose naloxone infusion could reduce tramadol induced side effects without reversing its analgesia effects.