曲马多预防瑞芬太尼麻醉后早期疼痛的效果观察

目的：探讨曲马多对于瑞芬太尼麻醉之后出现早期疼痛的临床预防效果。方法：90例在静脉麻醉联合喉罩下进行腹腔镜胆囊切除手术的患者，分为3组（每组30例），分别在手术近结束缝合皮肤的时候，行静脉注射曲马多2mg,／Bg（A组），氯胺酮0．5mg／Bg（B组），生理盐水2mL（C组）。所有的患者均以丙泊酚、瑞芬太尼以及罗库溴铵进行麻醉诱导，手术中以丙泊酚、瑞芬太尼来维持麻醉，手术毕送入麻醉后恢复室。在患者出现了中等程度的疼痛（疼痛的视觉模拟评分（VAS）≥6分）的时候，给予曲马多2mg／Bg，并记录术后的苏醒时间、患者的喉罩拔除的时间、手术后镇痛药物的使用率、VAS评分、以及患者的各项生命体征、不良反应。患者苏醒之后30min内进行评分，以VAS≥6分为镇痛失败。结果：该3组患者在手术结束之后苏醒时间、患者喉罩拔除的时间及各时点的血压、心率比较差异均无显著性（P〉0．05）；在患者苏醒后的1min，10min，20min，0．5h，4h的VAs评分中，A组和B组均低于C组（P〈0．05）；在镇痛药物的使用率方面，A组和B组均低于C组（P〈0．01），且A组低于B组（P=0．01）；手术后患者的躁动率，A组和B组均显著的低于C组（P〈0．01）。结论：曲马多对瑞芬太尼麻醉后的早期疼痛有着明显的预防性作用，与氯胺酮相比较，效应更强。

The Postoperative Analgesic Effect of Tramadol Hydrochloride on the Patients Undergoing Remifentanil-based Anaesthesia

Objective ： To study the analgesic effect of tramadol hydrochloride on the patients undergoing laparoscopic cholecystectomy after remifentanil-based anaesthesia. Method： A total number of ninety ASA Ⅰ - Ⅱ adult patients who underwent the operation of laparoseopic choleeystectomy were divided into three groups randomly. Controlled group（Group C） ,Tramadol group（ Group A）and ketamine group（Group B）. Before the end of surgery, the patient of group A was given tramadol hydrochloride 2 mg/kg , group B was given ketamine 0. 5 mg/kg ,and group C was given 2mL 0.9% mtltural solution. All patients were inducted by using propofol, remifentanil and rocuronium, and maintned aneasthesia with propofol and remifentanil throughout the operation. In the recovery room,those patients were given tramadol 2mg/kg who felt the mod- erate pain（VAS score ≥6 ）. VAS score, the time of requiring analgesia by patients and adverse drug reactions such as nausea, vomit and diplopia were recorded for 30rain after surgery. Result： There were no significant differeee in postoperation recovery time,pharyngeal mask withdrew time , heart rate and blood pressure changes amorg the three groups （ P〉 0.05）. At the time of 1 min, 10 min,20 min,0.5 hours and 4 hours after patients regaining conseiousne：ss, the VAS scores of group A and group B were significantly lower than that of group C （ P 〈0.05 ） , the frequency of patients requiring analgesia in group A and group B were also significantly lower than that in group C （ P 〈0.01 ） , and moreover group A were lower than group B （ P = 0.01 ） ,the adverse drug reaction showed no significant difference except that the incidence of restlessness of group A and B were significantly lower than that in group C （ P〈 0.01 ）. Conclusion： As well as ketamine , tramadol hydrochloride has significant analgesic effect on patients with postoperative hyperalgesia after remifentanil-based anaesthesia.