曲马多对瑞芬太尼复合静脉麻醉后疼痛致敏的预防

目的在以瑞芬太尼为基础的丙泊酚复合静脉麻醉中,由于瑞芬太尼的作用时间超短,且可产生术后急性疼痛致敏,因此必须有良好的预防方案。该研究旨在对比曲马多及吗啡用于上述术后急性疼痛的预防及治疗的效果和安全性。方法下腹部手术患者60例,随机分为吗啡组（M组）与曲马多组（T组）,每组各30例。均以瑞芬太尼0.2μg.kg-1.m in-1联合丙泊酚6 m.gkg-1静脉麻醉,并跟据脑电双频指数（B IS）值及血流动力学指标微调上述两药。手术结束前20 m in,M组给予吗啡0.15 m.gkg-1,T组给予曲马多3 m.gkg-1。于手术结束前约5 m in停止丙泊酚泵注,瑞芬太尼输注至缝皮结束。观察患者由停用瑞芬太尼至苏醒（OAA/S评分至5分）时间、拔出气管插管时的血流动力学指标、苏醒后30 m in时的视觉模拟疼痛评分（VAS）,以及患者术后恶心、呕吐与寒战的发生情况。结果 M组较T组患者的苏醒时间显著延长〔（13.10±2.34）vs（7.17±1.56）m in,P〈0.01〕;拔管期的血流动力学指标无明显差异;苏醒后的VAS疼痛评分虽有差异,但均在临床有效镇痛范围。术后发生恶心、呕吐患者2组均较多,寒战发生率M组和T组比较差异无统计学意义（10.0%vs0,P〉0.05）。结论对瑞芬太尼静脉麻醉相关的术后急性疼痛致敏的预防中,曲马多和吗啡均有良好的效果。与吗啡比较,曲马多对患者术后苏醒延迟的影响更小,且有减少术后寒战的作用。

Preventive effect of tramadol on postoperative hyperaigesia after remifentanil-based anesthesia

Objective To compare the efficacy and safety of tramadol and morphine for preventing and treating postoperative hyperalgesia after remifentanil-based anesthesia.Methods Sixty patients underwent lower abdominal operation were randomly divided into two groups（n=30 each）：morphine group（M group） and tramadol group（T group）.The venous anesthesia was taken using remifentanil（0.2 μg·kg-1·min-1） combining with propofol（6 mg·kg-1） in the two groups,and the doses mentioned above drugs were modified based on bispectral index（BIS） and hemodynamic indexes.At 20 min before finishing operation,morphine（0.15 mg·kg-1） was given in M group,and tramadol（3 mg·kg-1） was given in T group.At 5 min before finishing operation,pump infusion of propofol was stopped,but pump infusion of remifentanil was continued till ending the suture of skin.The time from stopping infusion of remifentanil to awaking,the hemodynamic indexes during pulling out tracheal cannula,the Visual Anaglogue Scale（VAS） at 30 min post awaking and postoperative nausea,vomiting and chill were observed.Results The awaking time was markedly postponed in M group compared with T group（（13.10±2.34） vs（7.17± 1.56） min,P0.01）.The hemodynamic indexes had no significant difference during pulling out cannula in two groups.The VAS were in effective analgesic range despite they had difference in two groups.The incidence of postoperative nausea and vomiting were all high,and the incidence of chilling in M group and T group had no significance（10.0% vs 0,P0.05）.Conclusions Both tramadol and morphine have a better efficacy in preventing acute postoperative hyperalgesia of remifentanil-related venous anesthesia,but tramadol has less influence on delay of awakening and may reduce the occurrence of postoperative chills.