曲马多对术后不同程度寒战治疗效果的观察

目的观察使用剂量为1mg/kg的曲马多治疗手术后发生不同程度的寒战时的效果。方法 100例ASAⅠ～Ⅱ级,年龄18～65岁,在手术后发生寒战的病例,根据寒战程度的不同分为轻（A组,n=45）、中（B组,n=32）、重（C组,n=23）三组。所有的患者在确诊寒战后均给予1mg/kg的曲马多,观察给药后2min（T2）、5min（T5）、10min（T10）寒战症状的改善情况,若在T10仍为中度或以上寒战时,则追加1mg/kg的曲马多,并在10min后,再次评估寒战的程度。观察给药过程中恶心呕吐以及SpO2的改变情况。总结患者手术中及复苏时的情况,包括手术时长,手术过程中的输液量、尿量、输血例数和失血量、PACU辅助呼吸时长、复苏当天PACU室内温度。结果 T2时,A组寒战的消除率为84.4%,B组为15.6%,C组为0,但缓解率为56.5%;T5时,A组寒战的消除率为100%,B组为81.2%,C组为21.7%,缓解率为95.7%;T10时,B组消除率为93.7%,C组为69.6%;B组两例患者使用了追加剂量的曲马多,C组4例患者使用了追加剂量的曲马多,T20时,B组仍有1例患者为中度寒战,C组则有2例轻度,1例中度。结论 1mg/kg的曲马多对各种程度的寒战均有一定的治疗效果,对轻、中度即时效果明显,重度寒战则效果欠佳,需要更长的时间和更多的药物。

Effect of tromadal on different grade of postoperative shivering

Objective To observe the effect of tromadal on postoperative shivering in different grade.Methods 100 ASAⅠ~Ⅱ patients aged 18~65 years who had postoperative shivering during recovery from general anesthesia were divided into three groups by the grade of the shivering:mild(Group A,n=45),moderate(Group B,n=32),severe(Group C,n=23).All patients were administered tromadal via intravenous at the dosage of 1mg/kg after being diagnosed with postoperative shivering,and the following shivering grade were accessed at 2 min(T2),5min(T5) and 10 min(T10) after tromadal was administered.Additional 1 mg/kg of tromadal was administered if the shivering grade was moderate or higher at T10,and shivering grade were accessed 10 min(T20) later.Factors of surgery and anesthesia recovery were recorded and analyzed including the duration of surgery,fluids transfused,blood lost,cases of blood transfusion,volume of urine,duration of assisting ventilation and the temperature of the post anesthesia recover room.Nausea and vomiting and pulse oxygen saturation were also observed in case of the side effects.Results Shivering disappeared at ratio of 84.4% in group A,15.6% in Group B,0% in Group C at T2,while the relief ratio of shivering is 56.5% in Group C;there were no patients shivering at T5 in Group A,while shivering disappeared at ratio of group B is 81.2%,and in Group C is 21.7%,and the relief ratio of shivering is 95.7%;Shivering disappeared at ratio of 93.7% in group B,69.6% in Group C at T10.There were 2 patients in Group B received additional tromadal for moderately shivering and 3 in Group C at T10 and 1 for severe in Group C.There still was 1 patient had moderate shivering in Group B at T20 while 1 moderate and 2 mild in Group C.Conclusion Administered in the dosage of tromadal at 1 mg/kg has different effect of each grade on postoperative shivering,which is obvious in mild and moderate grade while takes times and more drugs in severe.