曲马多持续静脉滴注对剖宫产术中寒颤的影响

Effect of continuous intravenous infusion of tramadol on shivering in cesarean section

目的观察曲马多持续静脉滴注对剖宫产术中产妇寒颤及并发症的影响。方法 120例ASA I^II级择期剖宫产随机分为3组:安慰剂组(C组),静脉注射NS 5 m L;曲马多组(Q组),曲马多1.2 mg/kg静脉注射;持续曲马多组(CQ组),曲马多0.2 mg/kg静注,然后1 mg/kg稀释到50 m L微泵持续静滴。记录入室时(T_1)、麻醉后(T_2)、手术开始时(T_3)、胎儿取出后(T_4)、子宫肌注缩宫素后(T_5)、缝合子宫后(T_6)、关闭腹膜后(T_7)、术毕(T_8)各时点的平均动脉压(MAP)、心率(HR),采用De Witte评定产妇术中、术毕寒颤程度;采用WHO记录产妇恶心呕吐情况。结果曲马多的应用方法不同对MAP的影响与时间不存在交互效应(F=0.77,P=0.6728),对HR的影响与时间存在交互效应(F=13.31,P<0.01)。C组患者术中寒颤程度最重,术毕时CQ组患者的寒颤程度最轻,Q组患者术中恶心呕吐情况最重(均P<0.01)。结论曲马多持续静滴与静脉注射均可有效降低产妇术中寒颤程度,但曲马多静脉注射时术毕寒颤复发情况及产妇恶心呕吐发生较多,曲马多持续静滴并不增加产妇术中恶心呕吐发生。

Objective T_o investigate the effect of continuous intravenous infusion of tramadol on shivering of the patients in cesarean section. Methods One hundred and twenty parturients of ASA Class I-II subject to elective cesarean section were randomly divided into three groups： placebo group（Group C）, receiving 5ml NS IV; tramadol group（Group Q）, receiving tramadol 1.2mg/kg IV; continuous tramadol group（Group CQ）, receiving tramadol 0.2mg/kg IV and tramadol 1mg/kg diluted to 50 ml intravenous infusion by micropump. Heart rate（HR） and mean arterial pressure（MAP） of all parturients were recorded when entering operation room（T_1）, after spinal-epidual anesthesia（T_2）, at the beginning of surgery（T_3）, at the time of expulsion（T_4）, after uterus intramuscular injection with oxytocin（T_5）, after suturing the uterus（T_6）, after suturing the peritoneum（T_7） and at the end of operation（T_8）. De Witte was used to evaluate the shivering of the parturients during operation and at the end of operation; and WHO standard classification was used to record the nausea and vomiting occurring in parturients. Results HR was the fastest in Group C compared with Group Q and Group CQ at T_4, T_5 and T_6, HR was the lowest in Group CQ compared with Group C and Group Q at T_7 and T_8; the effect of different administration methods of tramadol on MAP had no interaction with time（F=0.77, P=0.6728）, but the effect of different administration methods of tramadol on HR had interaction with time（F=13.31, P〈0.01）. Shivering in Group Q or Group CQ was decreased compared with Group C during operation. Shivering in Group C or Group Q was increased compared with Group CQ at the end of operation. Nausea and vomiting in Group Q was the mildest（P〈0.01）. Conclusion Continuous intravenous infusion and intravenous injection of tramadol can both effectively decrease the degree of shivering during cesarean section, but for intravenous injection of tramadol, more parturients had recurrent shivering as well as nausea and vomiting after operation. However, continuous intravenous infusion of tramadol does not increase the incidence of nausea and vomiting during the operation.