多沙普仑 曲马多 氟芬合剂预防全身麻醉术后寒战的观察

目的探讨多沙普仑、曲马多和小剂量氟芬合剂预防全身麻醉术后寒战的效能及对呼吸循环功能的影响。方法选择ASAⅠ~Ⅱ级择期手术患者80例,随机分为4组:0.9%生理盐水组(N组)、多沙普仑组(D组)、曲马多组(T组)、氟芬合剂组(F组)。麻醉诱导:昂丹司琼0.1 mg/kg、咪唑安定0.1 mg/kg、芬太尼1~2μg/kg、维库溴铵0.1 mg/kg、依托咪酯0.2 mg/kg。麻醉维持:丙泊酚4~10 mg.kg-1.h-1持续泵入,间断追加芬太尼、维库溴铵。手术结束前10 min停药,术毕,N组注入生理盐水5 mL,D组注入多沙普仑1 mg/kg,T组注入曲马多1 mg/kg,F组注入氟芬合剂0.5μg/kg。记录注药后5、10、30 min寒战发生例数和平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)变化值,同时记录各组的苏醒时间。结果与对照组比较,注药后103、0 min,多沙普仑组、曲马多组、氟芬合剂组寒战发生率显著下降(P<0.01),后3组相比差异无统计学意义(P>0.05);注药前后,多沙普仑组、曲马多组MAP、HR无显著变化(P>0.05),氟芬合剂组MAP、HR有下降趋势,但差异无统计学意义(P>0.05)。注药后多沙普仑组、曲马多组、氟芬合剂组SpO2较注药前差异无统计学意义(P>0.05)。多沙普仑组与对照组、曲马多组及氟芬合剂组相比,苏醒时间明显缩短,差异有统计学意义,氟芬合剂组与对照组、曲马多组相比,苏醒时间差异无统计学意义(P>0.05)。结论多沙普仑、曲马多以及小剂量氟芬合剂可有效预防全麻术后寒战发生,且对呼吸循环功能无明显影响,小剂量氟芬合剂的应用无苏醒延迟发生。

The preventing effect of Doxapram,Tramadol and Fentanyl-Droperidol on the shivering after general anesthesia

Objective To investigate the effectiveness of doxapram,tramadol and the small dose of fentanyl-droperidol in the prevention of shivering after general anesthesia and its effect on the respiratory and circulatory functions.Methods ASA Ⅰ～Ⅱ level,totally 80 participants,were randomly divided into four groups: 0.9% saline group(N),doxapram group(D),tramadol group(T),fentanyl-Droperidol group(F).Induction of anesthesia: midazolam 0.1mg/kg,fentanyl 1～2 μg/kg,vecuronium 0.1 mg/kg,etomidate 0.2 mg/kg.Maintenance of anesthesia: propofol 4～10 mg·kg-1·h-1 continued to pump,intermittent additional fentanyl and vecuronium.Anesthesia withdrawal 10 minutes before the end of surgery.In the end of operation,N group was injected with normal saline 5 mL,D group into doxapram 1 mg/kg,T group into tramadol 1 mg/kg,F Group into Fentanyl-Droperidol mixture 0.5 μg/kg.Recording the cases of shivering and changes of MAP,HR,SpO2 in the time point 5 min,10 min,30 min after injection,while recording the recovery time of each group.Results There was no significant difference(P>0.05) among four groups of patients in age,gender,height,weight,anesthesia time,surgery time.In the time point 10 min,30 min after injection,compared with the control group,doxapram group,tramadol group and group F,chill rate decreased significantly(P<0.01),the last three groups showed no significant difference(P>0.05);Compared with the time before injection,the level of MAP,HR in the doxapram group and tramadol group had no significant changes(P>0.05),the level of MAP,HR in the Group F seemed to be downward,but there was no significant difference(P>0.05).There was no significant difference in the level of SpO2 after injection of doxapram,tramadol and Fentanyl-Droperido;It was significantly shorter in recovery time in group D than the control group, tramadol group and group F.There was no significant difference in the recovery time between group F and the control group,tramadol group(P>0.05).Conclusions Doxapram,tramadol and the small dose fentanyl droperidol can be effective in preventing the shivering after general anesthesia,they don′t affect the respiratory and circulatory functions,small doses fentanyl droperidol has no delayed recovery.