曲马多与氯胺酮对瑞芬太尼麻醉后早期疼痛的预防效果观察

目的比较曲马多与氯胺酮对瑞芬太尼麻醉后早期疼痛的预防效果和不良反应。方法60例全凭静脉麻醉联合喉罩下行腹腔镜胆囊切除手术的患者分为3组（每组20例）,分别在手术近结束缝合皮肤时静脉注射曲马多2mg/kg（T组）、氯胺酮0.5mg/kg（K组）、生理盐水2ml（C组）。所有患者以丙泊酚、瑞芬太尼、罗库溴铵麻醉诱导,术中以丙泊酚、瑞芬太尼维持麻醉,术毕送麻醉后恢复室。当患者出现中等程度疼痛[疼痛视觉模拟评分（VAS）≥6分）]时给予曲马多2mg/kg,记录术后苏醒时间、喉罩拔除时间、VAS评分、术后镇痛药物使用率以及各项生命体征和不良反应,苏醒后30min内评分,VAS≥6分者视为镇痛失败。结果3组患者手术结束后苏醒时间、喉罩拔除时间以及各时点心率、血压比较差异均无显著性意义（P〉0.05）;苏醒后1min、10min、20min、0.5h、4h的VAS评分T组、K组均低于C组（P〈0.05）;镇痛药物使用率T组、K组均低于C组（P〈0.01）,T组亦低于K组（P=0.01）;术后躁动率T组、K组均显著低于C组（P〈0.01）。结论曲马多对瑞芬太尼麻醉后早期疼痛有明显预防作用,与氯胺酮比较效应更强。

The postoperative analgesic effect of tramadol hydrochloride and ketamine on the patients undergoing remifentanil-based anaesthesia

Objective To study the analgesic effect of tramadol hydrochloride or Ketamine on the patients undergoing laparoscopiccholecystectomy after remifentanil-based anaesthesia. Methods A total number of sixty ASA Ⅰ～Ⅱ adult patients who underwent the operation of laparoscopiccholecystectomy were devided to three groups randomly.Controlled group（Group C,n = 20）、Tramadol group（（Group T,n = 20）and ketamine group（Group K,n = 20）.Before the end of surgery,the patient of group T was given tramadol hydrochloride 2 mg/kg ,group K was given ketamine 0.5 mg/kg ,and group C was given 2ml 0.9% natural solution.All patients were inducted by using propofol,remifentanil,and rocuronium,and maintained aneasthesia with propofol and remifentanil throughout the operation. In the recovery room,those patients was given tramadol 2mg/kg who felt the moderate pain（VRS score ≥6 ）.VRS score,the time of requiring analgesia by patients and adverse drug reactions such as nausea,vomit and diplopia were recorded for 24 hours after surgery.Results There were no significant different in postoperation recovery time,pharyngeal mask withdrew time ,heart rate and blood pressure changes between the three groups （P 0.05）. At the time of 1 min、10 min、20 min、0.5 h and 4 h after patients regaining consciousness,the VRS scores of group T and group K were significantly lower than that of group C （P 0.05）,the frequency of patients requiring analgesia in Group T and group K were also significantly lower than that in group C （P 0.05）,and also Group T were lower than group K （P = 0.01）,the adverse drug reaction showed no significant difference except that the incidence of restlessness of group T and K 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.