曲马多抑制全麻恢复期躁动反应及其量效和时效应的研究

Inhibition of tramadol on restlessness and its dose-response and time -effect relationship in recovery period of general anesthesia

目的 :探讨曲马多对全麻恢复期躁动反应的影响及其量效和时效关系。方法 :1 3 8例ASAⅠ～Ⅲ级成年经腹手术患者 ,实施异氟醚静吸复合插管全麻。双盲、随机分成空白对照组 (3 4例 )和用药组(1 0 4例 ) ,用药组分术毕前 3 0min 5 2例和术毕时 5 2例 ,静注剂量均为 1mg·kg- 1 和 2mg·kg- 1 曲马多。观察麻醉恢复期呼吸循环和应激变化 ,按Robertson法意识评分和Prince Henry疼痛评分 ,记录躁动等不良反应发生率及程度。结果 :术毕前曲马多 3 0min组与对照组比较 ,恢复期呼吸循环平稳 (P <0 .0 5 ) ,Prince Henry评分低 (P <0 .0 1 ) ,躁动反应轻 (P <0 .0 5 ) ,而术毕时与对照无差异 ,且清醒时间延长 ;用药组意识水平低于对照组 ,术毕时给药组更明显 ,但各组的拔管时间无差异。结论 :1～ 2mg·kg- 1 曲马多术毕前静注能有效抑制全麻恢复期躁动反应 。

AIM: To study the effect of tramadol on restlessness in reco ve ry period of general anesthesia and its dose-response and time-effect relation ship. METHODS: 138 adult patients (ASA Ⅰ-Ⅲ) following abdom inal surgery with isoflurane-balanced anesthesia were divided into 5 groups (a double-blind randomized study): control-group (n=34), T1 and T 2 group (tramadol given 1 and 2 mg·kg -1 , respectively, at the thirtieth m inute before the end of operation, n=26 ), and T3 and T4 group (tramadol 1 and 2 mg·kg -1 , respectively, at the end of operation, n=26). Some indices were observed including the changes of respiration and circulation, the conscious state with Robertson's conscious scores and pai n with Prince-Henry score, and the incidence and degree of adverse reaction. RESULTS: In comparison with control-group, the respiration and ci rculation were steady (P< 0.05 ) in T1 and T2, with lower Prin ce-Henry score(P< 0.01 )and light restlessness, but that w ere not difference in T3 and T4. The time of extubation was not difference betwe en each other, but consciousness level in the groups administered tramadol were lower than that in control group, and the lowest level existed at the end of ope ration in groups administered tramadol. CONCLUSION: Intravenous tramadol 1～2 mg·kg -1 can effectively inhibit restlessness in recovery pe riod of general anesthesia, but its effect is related to the time administered t ramadol.