曲马多辅助硬膜外阻滞对胆囊切除术牵拉反应的防治作用

目的 :评价曲马多作为硬膜外阻滞辅助药的安全性和可行性。方法 :硬膜外阻滞下行单纯胆囊切除术 6 0例 ,随机分为两组 ,研究组 (n =30 )静滴氟哌利多 5mg,曲马多 10 0mg ;对照组 (n =30 )静滴氟哌利多 5mg和度冷丁 5 0mg。观察两组病人的镇静程度、内脏牵拉反应和对循环呼吸影响。结果 :两组病人术中镇静程度和sPO2 变化无显著性差异(P >0 0 5 ) ;研究组对抗牵拉反应明显优于对照组 (χ2 =7 95 4 2 ,P <0 0 1) ,但胆心反射出现率无显著性差异 (11例和 6例 ,χ2 =2 0 5 2 ,P >0 0 5 )。结论 :采用曲马多 1.5mg/kg与氟哌利多 5mg静脉辅助 ,具有良好的镇静和较强的抗内脏牵拉反应效果 :用药后sPO2 和RR变化轻微 ,对于老年人或心脏功能欠佳者可作为度氟合剂的替代辅助药

Preventive Effect of Tramadol Used as an Adjuvant on Traction Reflex during Epdural Block for Cholecystectomy

Objective: To evaluate the efficiency and safety of tramadol used as an adjuvant on cholecystectomy during epdural block. Methods: Sixty patients were divided randomly into two groups with 30 patients each. After epidural blockade was established,dreperidol 5mg and tramadol 100mg were infused in the research group patients (GroupⅠ,n=30),while dreperidol 5mg and meperiding 50mg were infused in the control group patients (GroupⅡ,n=30). The depth of sedation ,traction reflex of abdominal organs and the effects of circulatory-respiratory system the drugs in two groups were observed. Results: The depth of sedation and sPO_2 had no significance between two groups (P>0.05). GroupⅠwas better than group Ⅱin anti-traction reflexes(χ~2=7.9542, P<0.01),but the incidence of gallbladder-heart reflex had no statistical difference (11 and 6 cases,χ~2=2.052,P>0.05). Conclusion: Tramadol 1.5mg/kg and droperidol 5mg are used as epidural adjuvant have some advantages of better sedation, stronger anti-traction reflex and less breathing depression, therefore, tramadol -droperidol may substitute for meperiding-droperidol mixture. Especially for aged patients or those who have poor cardio-lung function.