天津医药

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不同剂量曲马多超前镇痛用于七氟醚小儿麻醉的临床研究

宋丽1,施森1,魏继承2,欧册华2   

  1. 1. 泸州医学院附属医院
    2.
  • 收稿日期:2009-08-07 修回日期:2009-10-12 出版日期:2010-04-15 发布日期:2010-04-15
  • 通讯作者: 宋丽

Clinical research of Preemptive analgesia with different dosage tramadol in pediatric anesthesia with sevoflurane

  • Received:2009-08-07 Revised:2009-10-12 Published:2010-04-15 Online:2010-04-15

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摘要： 【摘要】目的 探讨不同剂量曲马多超前镇痛对学龄儿童七氟醚吸入麻醉的术后苏醒时间、拔管时间、循环、苏醒期躁动及镇静程度的影响。方法 选择行阑尾切除术的患儿90例，年龄6～10岁，ASAⅠ级，随机分为小剂量曲马多组（T1）、大剂量曲马多组（T2）及对照组（C），每组30例。各组患儿以七氟醚、芬太尼和阿曲库铵诱导插管， T1、T2组分别于气管插管后静脉注射曲马多1mg/kg、2mg/kg，C组静脉注射生理盐水，术中吸入七氟醚维持麻醉，术毕待患儿清醒拔管。结果 各组患儿呼唤睁眼时间、拔管时间和脉氧饱和度（SpO2）比较无明显差异。与C组相比， T2组患儿拔管时及拔管后10分钟的心率（HR）、平均动脉压（MAP）明显降低，术后躁动发生率明显下降，术后镇静满意率明显升高 (P<0．01)，T1组HR、 MAP及躁动发生率有一定下降，但差异无统计学意义（P>0．05）。结论 2mg/kg的曲马多可以有效预防学龄儿童七氟醚吸入麻醉术后躁动的发生，获得较为满意的镇静效果，拔管时及拔管后循环更平稳，且不影响术后苏醒时间和拔管时间。

关键词: 曲马多, 超前镇痛, 七氟醚, 儿童, 躁动

Abstract: 【Abstract】objective To investigate the influence of preemptive analgesia with different dosage tramadol in children with inhalational anesthetic sevoflurane on postoperative palinesthesia time, extubation time, circulation, postoperative agitation and conscious-sedation extent. Methods Ninty children(ASAⅠgrade)undertaking appendectomy were randomly divided into low dose tramadol group(group T1，n=30) , large dose tramadol group(group T2，n=30) and control group(group C，n=30).Anaesthesia was induced with sevoflurane,fentanyl and atracurium for tracheal intubation. In group T1 and group T2, 1mg/kg and 2mg/kg tramadol was administered intravenously after intubation, and in group C, normal saline was administered intravenously, anaesthesia was maintained with sevoflurane. Extubation was accomplished after the children awaked. Results There was no significant difference of palinesthesia time, extubation time and pulse oxygen saturation among three groups(P>0．05).Compared with group C,the heart rate（HR）and mean arterial pressure（MAP）of extubating and ten miniutes after extubating in group T2 decreased significantly, the incidence of postoperative agitation in group T2 also decreased significantly,and conscious-sedation extent increased significantly(P<0．01)，the HR,MAP and the incidence of postoperative agitation in group T1 decreased slightly,but there were no statistic difference（P>0．05）。Conclusion 2mg/kg tramadol could prevent postoperative agitation effectively in school children receiving inhalational sevoflurane,obtained satisfactory conscious-sedation extent and stable circulation when extubating and after extubating,and also,there were no influence on postoperative palinesthesia time and extubating time.

Key words: tramadol, Preemptive analgesia, sevoflurane, children, agitation