酮咯酸氨丁三醇超前镇痛对扁桃体切除术患者血流动力学的影响

Effects of preemptive analgesia with ketorolac tromethamine on hemodynamics in patients undergoing tonsillectomy

目的观察酮咯酸氨丁三醇超前镇痛对扁桃体切除术患者气管拔管期血流动力学的影响及术后的镇痛效果。方法选择择期行双侧扁桃体切除术的全麻患者60例,随机分为2组:观察组(酮咯酸氨丁三醇30 mg),对照组(生理盐水)。手术开始前15 min,观察组静注酮咯酸氨丁三醇30 mg,对照组静注等剂量生理盐水。记录两组患者的一般资料,入室、拔管即刻、拔管后5 min、拔管后10 min患者的收缩压、舒张压、心率、血氧饱和度,苏醒期躁动评分,拔管后5 min、10 min、1 h时的OAA/S评分和拔管后1、4、6、12 h的VAS评分,记录患者的手术时间、麻醉时间、拔管时间及术后不良反应。结果拔管即刻及拔管后5、10 min,观察组的SBP为(124.9±7.7)、(120.3±9.2)、(118.9±9.3)mm Hg,DBP为(73.8±5.9)、(71.8±8.1)、(69.5±8.0)mm Hg;对照组的SBP为(138.0±9.4)、(134.9±11.0)、(132.7±10.8)mm Hg,DBP为(82.3±8.5)、(80.6±9.6)、(79.8±8.5)mm Hg,观察组各时点的血压均低于对照组,差异有统计学意义(P<0.05)。拔管后1、4、6、12 h,观察组的VAS评分为1.0±0.8、1.4±0.7、2.2±1.0、2.8±0.6,对照组为2.7±1.0、3.5±1.1、4.1±1.0、3.2±1.1,观察组评分低于对照组(P<0.05)。结论酮咯酸氨丁三醇30 mg超前镇痛用于成人双侧扁桃体切除术患者气管拔管期血流动力学波动小,镇痛效果良好。

Objective To evaluate the preemptive analgesia effect of ketorolac tromethamine on tonsillectomy patients,and observe the hemodynamic changes during tracheal extubation and postoperative analgesia efficacy.Methods Sixty adult patients scheduled for tonsillectomy under general anesthesia were enrolled and randomly divided into observation group and control group：observation group were intravenously injected ketorolac tromethamine（30 mg）and control group were intravenously injected isodose physiological saline at 15 min before operation.The general information,SBP,DBP,HR,SpO_2 and awaken agitation score were recorded.The OAA/S score at 5,10 and 60 min after tracheal extubation and VAS score at 1,4,6 and 12 h after tracheal extubation of the two groups were compared.The time of operation,anesthesia and extubation and adverse reactions were recorded.Results The SBP in observation group at 0,5 and 10 min after tracheal extubation were（124.9±7.7）,（120.3±9.2） and（118.9±9.3） mmHg,and the DBP were（73.8±5.9）,（71.8±8.1） and（69.5± 8.0） mmHg;the SBP in control group at 0,5 and 10 min after tracheal extubation were（138.0±9.4）,（134.9± 11.0） and（132.7± 10.8） mmHg,and the DBP were（82.3±8.5）,（80.6±9.6） and（79.8±8.5） mmHg.There were significant differences in SBP and DBP between the two groups at different time points（P〈0.05）.The VAS at 1,4,6 and 12 h after tracheal extubation in observation group（1.0±0.8,1.4±0.7,2.2± 1.0 and 2.8±0.6） were lower than those of control group（2.7±1.0,3.5±1.1,4.1±1.0 and 3.2± 1.1）,there being significant differences between the two groups（P〈0.05）.Conclusion Ketorolac tromethamine（30 mg） treatment for patients undergoing tonsillectomy as preemptive analgesia has stable hemodynamic change with good efficacy.