曲马多抑制瑞芬太尼致术后患者痛觉过敏的临床观察

目的：观察曲马多对瑞芬太尼所致术后痛觉过敏的抑制作用。方法：上腹部择期手术患者60例,ASAⅠ～Ⅱ级,随机分为3组,各20例,均采用瑞芬太尼和丙泊酚全静脉麻醉,间断给予顺式阿曲库铵。A、B两组分别于手术结束前15 min静脉给予曲马多,A组为1 mg/kg,B组为2 mg/kg,C组对照给予芬太尼1μg/kg。记录各组苏醒时间、拔管时间、拔管时患者的血流动力学指标、拔管后的VAS评分、Ramsay评分及要求镇痛距离拔管的时间、拔管后苏醒室内患者恶心呕吐及呼吸抑制等不良反应的情况。结果：拔管时血流动力学指标3组比较差异无统计学意义（P〉0.05）,苏醒时间及拔管时间C组最长。苏醒后VAS评分A组最高,B组和C组次之（P〈0.05）,B组和C组间比较差异无统计学意义（P〉0.05）;Ramsay评分3组比较差异无统计学意义（P〉0.05）。呼吸抑制C组发生率最高,C组和B组恶心呕吐发生率高于A组。结论：手术的患者于手术结束前15 min静脉注射2 mg/kg曲马多可安全有效地减轻瑞芬太尼麻醉后的痛觉过敏。

Clinical Observation of the Postoperative Hyperalgesia of Patients Induced by Tramadol Inhibiting Remifentanil

Objective:To observe the influence of tramadol on postoperative hyperalgesia induced by remifentanil.Methods:Sixty patients(ASA gradeⅠ to Ⅱ) undergone upper abdominal selective operation were randomly divided into three groups(n=20) to be treated by the total intravenous anesthesia of remifentanil,propofol and intermittent intravenous Cis-atracurium.Before 15 min of finishing the operation,the patients in group A and B were given intravenous tramadol(1 mg/kg to the group A,2 mg/kg to the group B) respectively and the patients in the control group C were given fentanyl 1μg/kg to record the recovery time,extubation time,hemodynamics index of patients at extubation,VAS scores after extubation,Ramsay scores and the time of requiring analgesia from extubation,the status of adverse reactions of nausea and vomiting and respiratory inhibition after extubation of the patients in recovery room in each group.Results:There was no statistical significance of hemodynamics index at extubation comparing between the three groups(P>0.05).The time of recovery and extubation was longest in the group C.The VAS scores after recovery were highest in the group A and lower in the group B and C(P<0.05).There was no statistical significance comparing between the group B and C(P>0.05).There was no statistical significance comparing Ramsay scores in three groups(P>0.05).The incidence of respiratory inhibition happened highest in the group C and the incidence of nausea and vomiting in the group B and C occurred higher than those in the group A.Conclusion:It could safely and effectively reduce the hyperalgesia after remifentanil anesthesia to do intravenous injection of 2 mg/kg tramadol before 15 min of the operation for the operative patients.