曲马多联合小剂量丙泊酚治疗腰硬联合麻醉剖宫产寒战疗效观察

Observation on effect of tramadol combined with small dose of propofol in treating shivers during caesarean section under combined spinal and epidural anaesthesia

目的 观察曲马多联合小剂量丙泊酚对腰硬联合麻醉剖宫产中寒战的治疗效果。方法 选择2015年6-12月重庆市妇幼保健院收治的90例在腰硬联合麻醉下行剖宫产出现寒战的产妇,将其分为三组,每组30例。在产妇发生寒战后,Ⅰ组给予曲马多1 mg/kg,Ⅱ组给予曲马多1 mg/kg和丙泊酚0.5 mg/kg,Ⅲ组给予相同剂量生理盐水。监测产妇麻醉前后及用药前后平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）。记录并观察用药后寒战治疗效果、镇静程度、恶心、呕吐发生情况。结果 三组产妇麻醉前后及用药前后平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）比较,差异均无统计学意义（P〉0.05）;Ⅰ组与Ⅱ组用药后寒战明显缓解,与Ⅲ组比较,差异均有统计学意义（P〈0.01）,但Ⅰ组与Ⅱ组比较,差异无统计学意义（P〉0.05）;Ⅱ组恶心、呕吐发生率（6.67%,2/30）显著低于Ⅰ组（40.00%,12/30）和Ⅲ组（33.33%,10/30）,差异均有统计学意义（P〈0.05）,但Ⅰ组与Ⅲ组比较,差异无统计学意义（P〉0.05）。三组均未发生过度镇静和呼吸抑制。结论 曲马多联合小剂量丙泊酚能有效治疗腰硬联合麻醉剖宫产中的寒战,并能减少恶心、呕吐的发生情况。

Objective To observe the effect of tramadol combined with small dose of propofol in treating shivers during caesarean section under combined spinal and epidural（CSE） anesthesia. Methods Ninety cases of shiver occurred during caesarean section under CSE anesthesia were selected from June to December 2015 and randomly divide into 3 groups with 30 cases in each group. After shiver occurrence,the group I was given tramadol 1mg/kg,the group II was given tramadol 1 mg/kg and propofol 0.5 mg/kg, and the group III as the control group was given the same dose of normal saline. MAP,HR and SpO2 were monitored before and after anesthesia. The treatment effect, sedation degree and occurrence situation of nausea and vomiting were recorded after medication. Results MAP, HR aud SpO2 before and after anesthesia and before and after medication had no sta tistical differences among 3 groups （P〉0.05） ;shiver after medication in the group I and II was significantly improved,which had statistical difference compared with the group III （P〈0.05）,but which had no statistical difference between the group I and II （P〉 0.05 ） ;the occurrence rate of nausea and vomiting in the group II was 6.67% （2/30） ,which was significantly lower than 40.00% （12/30） in the group I and 33.33% （10/30） in the group III ,the difference was statistically significant （P〈0.05）,but the difference between the group I and III had no statistical significance（P〉0.05 ）. No excessive sedation and respiratory inhibition occurred in 3 groups. Conclusion Tramadol combined with small dose of propofol can effectively treat shiver during caesarean section under CSE anesthesia, and can reduce the occurrence of nausea and vomiting.