曲马多超前镇痛在全凭静脉麻醉妇科腹腔镜手术中的评价

目的评价妇科腹腔镜手术中曲马多超前镇痛两种用药模式的有效性及安全性。方法90例ASAⅠ～Ⅱ级妇科腹腔镜手术病例随机分为3组：以丙泊酚、芬太尼、琥珀胆碱麻醉诱导气管插管，术中瑞芬太尼、丙泊酚及维库溴铵维持麻醉，T1组术前静注曲马多100mg，T2组于术前、术毕分别静注100mg曲马多，C组为生理盐水对照组。观察术后苏醒时间及质量，术后随访24hVAS疼痛评分、镇痛药使用及不良反应发生情况等。结果术后苏醒时间3组无明显差异，但15min时镇静评分T2组明显高于另外两组（P〈0．05），30min之后3组无明显差异；术后虽然T1组0．5、1、2hVAS评分明显低于C组（P〈0．05），但仍有10例病人另外使用了镇痛药；T2组24h内各时点VAS评分都很低，0．5、1、2、4、6h的VAS显著低于T1组（P〈0．05），且无人另外使用镇痛药。T2组主诉视物模糊的病人显著多于另外两组．但术后1h均明显改善。结论仅术前静注曲马多产生的超前镇痛作用是有限的，曲马多术前和术毕各100mg静注可产生满意的超前镇痛效果，能有效地解除妇科腹腔镜微创手术后的疼痛，但术后早期可能镇静较深，还需加强监护。

Preemptive analgesia with tramadol in patients undergoing gynecological laparoscopic surgery by total intravenous anesthesia

Purpose To evaluate the efficacy and safety of two patterns of preemptive analgesia with tramadol in patients undergoing gynecological laparoscopic surgery. Methods Ninety patients were allocated randomly to receive iv tramadol 100mg preoperatively(group T1),both preoperatively and at the end of the surgery(group T2),or to receive iv normal saline(group C-Control).Anesthesia was induced with propofol,fentanyl and scoline for tracheal intubation and maintained with propofol,remifentanil and vecuronium.Time to recovery,sedation,pain score(VAS),the use of analgesics and side effects were recorded. Results There were no difference among the 3 groups regarding time to recovery,but group T2 had significantly higher sedation score compared to group T1 and group C at 15 minutes postoperatively.And after 30 minutes there were no differences among them.Although in group T1 VAS score was significantly lower at 0.5,1,2 hours postoperatively than group C((P<0.05)),10 patients of group T1 required supplemental analgesics.Group T2 had significantly lower VAS score compared to group T1 at 0.5,1,2,4 and 6 hours postoperatively(P<0.05),and no one needed supplemental analgesics.The incidence of blurry sight was higher in group T2 than other groups,but these patients showed obvious improvement at 1 hour postoperatively. Conclusions Pre-emptive analgesic effect using tramadol just preoperatively is limited,and iv tramadol 100mg given both preoperatively and at the end of the surgery could provide satisfying analgesic effect in patients undergoing gynecologic laparoscopic surgery,whereas intensive care was important because deep sedation may occur in the early postoperative period.