曲马朵超前镇痛对宫外孕腹腔镜手术患者苏醒期的影响

Effect of tramadol in application of preemptive analgesia on laparoscopic operation for ectopic pregnancy in the general anesthesia recovery period

目的观察曲马朵超前镇痛在宫外孕腹腔镜手术中对全身麻醉苏醒期的影响。方法将2013年6月至2014年3月辽宁省鞍山市妇儿/第五医院收治的56例宫外孕腹腔镜手术患者按照随机数字表法分为观察组和对照组,各28例。观察组患者麻醉诱导后于术前静脉注射曲马朵注射液1 mg/kg,而给予对照组患者等量生理盐水。测量并记录麻醉前(T0,基础值)、拔出喉罩前5 min(T1)、拔出喉罩时(T2)、拔出喉罩后10 min(T3)患者平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(Sp O2),观察并记录患者术后苏醒时间、T2时躁动评分(RS)、T3时患者疼痛视觉模拟评分(VAS),并观察患者恶心、呕吐等不良反应。结果两组患者T2时RS、T3时VAS比较,差异均有统计学意义(P<0.05);T0、T1时MAP、HR比较,差异均无统计学意义(P>0.05);T2、T3时MAP、HR比较,差异均有统计学意义(P<0.05)。对照组患者T2、T3时MAP、HR与T0时比较,差异均有统计学意义(P<0.05)。两组患者Sp O2比较,差异无统计学意义(P>0.05)。两组患者在苏醒期均未发生呼吸抑制病例,但各有1例患者出现恶心、呕吐现象。结论曲马朵超前镇痛应用于宫外孕腹腔镜手术安全、有效,并可提高患者苏醒期舒适度,而不延长患者苏醒时间,值得临床推广应用。

Objective To evaluate the effect of tramadol in application of preemptive analgesia on laparoscopic operation for ectopic pregnancy in the general anesthesia recovery period. Methods A total of 56 patients with ectopic pregnancy after laparoscopic operation received by Anshan Municipal Women and Children Hopsital/The Fifth Hospital of Anshan in Liaoning province from June 2013 to March 2013 were ramdonly divided into the observation group and the control group,each of 28 cases.The observation group was injected 1 mg/kg tramadol by vein before the operation after induction of anesthesia while the control group with the equivalent normal saline. It was observed the awakening time,VAS scores 10 min after pulling out laryngeal mask,RS scores at the moment of pulling out laryngeal mask, the MAP,HR and Sp O2 at T0（base value before anesthesia）,T1（5 min before pulling out laryngeal mask） and T3（10 min after pulling out laryngeal mask） as well as the other adverse effects such as nausea,vomiting and so on. Results It showed a statistical difference in VAS score at T2 and RS score at T3 between the two groups（P〈0.05）. There was no significant difference in MAP and HR at the time of T0 and T1（P〉0.05）;It showed a statistical difference in MAP and HR at the time of T2 and T3between the two groups. MAP and HR at T0 were compared with T2 and T3in（MAP,HR） in the control group,which showed a significantly statistical difference（P〈0.05）.There was no significant difference in Sp O2（P〉0.05）. The complications of respiratory depression in recovery stage weren′t found in the two groups. Only one case in each group occured nausea and vomiting. Conclusion The applicaiotn of tramadol for preemptive analgesia ectopic pregnancy is effective and safe,which can improve the comfort degree of patients and does not prolong the recovery time,being worthy for expanding in clinic.