曲马多在胆肠吻合术超前镇痛中的应用研究

Study on application of tramadol to preemptive analgesia in biliary enteric anastomosis

目的观察预注曲马多对胆肠吻合术患者术中与术后镇痛效果的影响,探讨曲马多在超前镇痛中的应用。方法择期行胆肠吻合术患者60例,随机双盲分为C组、T1组和T2组。C组在麻醉诱导前30 min和术毕前30 min分别注射生理盐水5 ml;T1组在麻醉诱导前30 min注射盐酸曲马多2 mg/kg(生理盐水5 ml稀释),在术毕前30 min注射生理盐水5 ml;T2组在麻醉诱导前30 min注射生理盐水5 ml,并在术毕前30 min注射盐酸曲马多2 mg/kg。所有患者麻醉维持均采用丙泊酚、雷米芬太尼、顺式阿曲库铵全凭静脉全身麻醉,术毕采用芬太尼自控静脉镇痛(PCIA)。记录术中雷米芬太尼的用量、术毕拔管情况及术后VAS评分、PCIA芬太尼用量和不良反应。结果术中麻醉维持T1组的雷米芬太尼用量及平均泵注速度均小于C组(P<0.05);T1组和T2组术后PCIA的VAS评分在0、6和12 h分别显著低于C组(P<0.05),且PCIA的按压次数和芬太尼用量亦显著低于C组(P<0.05);T1和T2组拔管时烦躁(P<0.01)和寒战(P<0.05)发生例数分别显著少于C组;拔管时T2组恶心发生例数多于C组(P<0.05),而术后PCIA过程中3组相差无统计学意义。结论胆肠吻合术患者可通过预注曲马多进行超前镇痛,术前预注效果可能更好。

Objective To investigate the influence of pre-injection of tramadol on perioperative and postoperative analgesic effects in patients who received biliary enteric anastomosis,and to discuss the application of tramadol to the preemptive analgesia. Methods Sixty patients undergoing selective biliary enteric anastomosis were randomly and double-blindly divided into group C,T1, and T2. Group C received the injection with 5 ml normal saline respectively at 30 minutes before the anesthesia induction and before the end of the operation. Group T1 received the injection with 2 mg/kg tramadol （ diluted by 5 ml normal saline） at 30 minutes before the anesthesia induction and with 5 ml normal saline at 30 minutes before the end of the operation. Group T2 received the injection with 5 ml normal saline at 30 minutes before the anesthesia induction and with 2 mg/kg tramadol at 30 minutes before the operation finished. Anesthesia was maintained with propofol, remifentanil, and eisatracurium, and all patients received controlled intravenous analgesia （PCIA） with fentanyl after the end of the operation. Recording was made in the consumption of remifentanil during the operation, the status of extubation at the end of the operation, the postoperative VAS score and the consumption of PCIA fentanyl, as well as adverse effects. Results The consumption and infusion velocity of remifentanil in group T1 were lower than those in group C （ P 〈 0.05 ）. The VAS scores of postoperative PCIA in group T1 and group T2 at 0,6, and 12 h were significantly lower than those in group C （ P 〈 0.05 ）, and the press times of PCIA and the consumption of fentanyl were also significantly lower than those in group C （ P 〈 0.05 ）. The numbers of cases with restlessness and shivering at the time of extubation in group T1 and T2 were less than that in group C （ P 〈 0.01 and P 〈 0.05 ）. The number of patients with nausea at the time of extubation in group T2 was more than that in group C （ P 〈 0.05 ）, but there was no significant difference among the three groups during the postoperative PCIA. Conclusion The patients undergoing biliary enteric anastomosis can receive the preemptive analgesia via the pre-injeetion with tramadol. Preoperational injection can achieve better effect.