不同剂量的芬太尼和曲马朵对预防全麻后苏醒期躁动的比较研究

目的探讨不同剂量芬太尼和曲马朵对预防全麻后苏醒期躁动的临床效果、不良反应和安全性。方法择期腹腔镜手术患者120例，随机分为曲马朵组（Q组）1、2、3mg／kg剂量组，芬太尼组（F组）0．1、0．2、0．3μg／kg剂量组，每组各20例。术毕前30min，Q组分别缓慢静脉输入曲马朵1、2、3mg／kg，F组分别缓慢静脉输入芬太尼0．1、0．2、0．3μg／kg。观察拔管前、拔管时、拔管后10min各组的躁动评分（RS）、镇静评分（RSS）和意识状态评分（0AAs）。结果Q组3mg剂量组RS评分低于1mg剂量组、2mg剂量组，差异有统计学意义（P〈0．05）。F组0．3μg／kg组RS评分低于0．1μg／kg组、0．2μg／kg组，差异有统计学意义（P〈0．05）。F组0．1μg／kg剂量组、0．2μg／kg剂量组、0．3μg／kg剂量组RS评分低于Q组1mg剂量组、2mg剂量组、3mg剂量组，差异有统计学意义（P〈0．05）。两组RSS评分差异无统计学意义（P〉0．05）。Q组1mg剂量组、2mg剂量组、3mg剂量组OAAS评分低于F组0．1μg／kg剂量组、0．2μg／kg剂量组、0．3μg／kg剂量组，差异有统计学意义（P〈0．05）。Q组3mg剂量组有3例拔管后SpO2〈95％需面罩加压给氧，F组0．2μg／kg剂量组有3例拔管后SpO2〈95％需面罩加压给氧，0．3μg／kg剂量组有10例拔管后SpO2〈95％需面罩加压给氧，0．3μg／kg剂量组有8例血压下降明显。结论芬太尼用于预防全麻后苏醒期躁动，效果明显优于曲马朵。芬太尼0．2μg／kg对呼吸、循环影响较小，较适合用于预防全麻后苏醒期躁动。

Comparing fentanyl with tramadol in preventing agitation after general anesthesia

Objective To compare fentanyl with tramadol in preventive agitation after general anesthesia. Methods One hundred and twenty patients undergoing laparoscopy under general anesthesia were randomly assigned into six groups（n=20）, group Q 1 mg/kg, 2 mg/kg, 3 mg/kg tramadol, and group F 0. 1 μg/kg, 0.2μg/kg, 0.3μg/kg fentanyl. RS, RSS, OAAS were recorded before extubation, during extubation and 10 min after extubation, side reactions were also observed. Results RS in the patients of group Q 3 mg/kg was apparently lower than that of group Q 1 mg/kg, 2 mg/kg （P〈0.05）. RS in the patients of group F 0.3μg/kg was apparently lower than that of group 0.1 μg/kg,0.2μg/kg（P〈0. 05）. RS in the patients of group F 0. 1μg/kg, 0. 2μg/kg 0.3μg/kg was apparently lower than that of group Q 1 mg/kg, 2 mg/kg, 3 mg/kg （P〈0.05）. RSS between group F and Q was no significantly difference（P〉0. 05）. OASS in the patients of group F 0. 1μg/kg, 0.2μg/kg 0.3 μg/kg was apparently higher than that of group Q 1 mg/kg, 2 mg/kg, 3 mg/kg, （P〈0.05）. Conclusion Fentanyl is better than tramadol in preventive agitation after general anesthesia, fentanyl 0.2 μg/kg with a few side effects is suitable for this objective.