静脉应用不同剂量曲马多超前镇痛对妇产科腹腔镜手术后疼痛的影响

目的 观察曲马多术前给药用于妇产科腹腔镜全麻术后镇痛的效果.方法 全麻下行妇产科腹腔镜手术80例,随机分为4组,每组20例,分别在手术切皮前静注:Ⅰ组生理盐水2 ml、Ⅱ组曲马多1.5 ms/ks、Ⅲ组曲马多2 ms/kg、Ⅳ组曲马多2.5 ms/kg.采用VAS评分和Ramsay镇静评分对患者拔管后、离室前以及术后1 h,2 h,4 h,8 h、12 h、24 h进行疼痛和镇静程度评分,并记录恶心、呕吐、头晕、嗜睡、躁动、恶梦、瘙痒、多汗等副作用.结果 与对照组Ⅰ相比,Ⅱ、Ⅲ、Ⅳ组在术后8 h内VAS评分显著降低,在3种剂量下未见量效相关性.4组Ramsay镇静评分均为0～2分.与Ⅰ组相比,Ⅱ、Ⅲ、Ⅳ组恶心、呕吐以及出汗的发生例数较多,Ⅳ与Ⅰ组相比有统计学差异,P<0.05或P<0.01;而Ⅱ、Ⅲ组与Ⅳ组之间的比较则无统计学差异.结论 妇产科腹腔镜全麻术前单次注射曲马多1.5 ms/kg～2 ms/kg可有效缓解术后疼痛,减少辅助镇痛药用量,副作用较少,是临床上较好的镇痛方法.

Effects of preoperative tramadol injection on postoperative analgesia in patients undergoing gynaecologiral laparoscopy

Objective To assess the effects of preoperative tramadol injection on postoperative analgesia in patients undergoing gynaecological laparoscopy. Methods A total of 80 patients scheduled for receiving gynaecological laparoscopic procedure under general anesthesia were randomly divided into four groups (n=20). 2 ml normal saline, 1.5 mg/kg, 2 mg/kg, 2.5 mg/kg tramadol was intravenously injected before anesthesia in Groups Ⅰ, Ⅱ, Ⅲ, Ⅳ, respectively. Visual analog scale (VAS) pain score and Ramsay sedation score were measured at postoperative 1 h, 2 h, 4 h, 8 h, 12 h and 24 h, respectively. Adverse effects were also recorded. Results The VAS score was significantly lower within postoperative 8 hours in Groups Ⅱ,Ⅲ and Ⅳ than that in Group Ⅰ, while no significant difference was found among Groups Ⅱ, Ⅲ and Ⅳ at each time point. The postoperative Ramsay sedation score was 0-2 in each group. Incidence of postoperative dysphoria, dizziness, nausea and vomiting was higher in Group IV than that in other groups. Conclusion The study suggests that preoperative injection of 1.5 mg/kg-2 mg/kg tramadol provides satisfactory postoperative analgesia in patients undergoing gynaecological laparoscopy, reducing the use of analgesics and the incidence of side effects.