妇科腹腔镜手术后不同镇痛药物的超前镇痛效应比较  

Preemptive analgesia with Ketamine,Tramadol and Fentanyi after gynecologic laparoscopic surgery:a comparison of outcomes

作　　者：胡建英[1] 黄绍强[1] 

机构地区：[1]复旦大学附属妇产科医院麻醉科,上海200011

出　　处：《上海医学》2007年第8期602-605,共4页Shanghai Medical Journal

摘　　要：目的比较术前静脉注射不同镇痛药物的超前镇痛效应。方法90例仅静脉麻醉下行妇科腹腔镜手术的患者随机均分为3组,分别于切皮前5 min静脉注射氯胺酮0.15 mg/kg(K组)、曲马多2 mg/kg(T组)、芬太尼2μg/kg(F组),所有患者以瑞芬太尼、丙泊酚、琥珀胆碱麻醉诱导,术中以丙泊酚、瑞芬太尼和维库溴铵维持麻醉。观察术后苏醒时间、镇静评分、疼痛视觉模拟(VAS)评分、术后镇痛药物使用率及不良反应发生率。结果T组在术后0.5、1、2、6 h的VAS评分显著低于K组(P值均<0.05),术后6h的VAS评分显著低于F组(P<0.05)。K组术后镇痛药物使用率(60%)显著高于T组(10%)及F组(33%),F组亦显著高于T组(P值均<0.05)。T组恶心、呕吐发生率(60%)显著高于K组(27%)及F组(20%,P值均<0.05)。结论与氯胺酮、芬太尼相比,曲马多的超前镇痛效应更强,但是恶心、呕吐的发生率较高。Objective To compare the effects of preemptive analgesia with ketamine, tramadol and fentanyl. before skin incision. Methods Ninety patients undergoing gynecologic laparoscopic surgery under total intravenous anesthesia were randomly divided into three groups： Ketamine 0.15 mg/kg （group K）, Tramadol 2 mg/kg （group T） and Fentanyl 2μg/kg （group F） ; all the agents were given intravenously 5 min before skin incision. Anesthesia was induced with remifentanil, propofol and scoline, maintained with propofol, remifentanil and vecuronium. Time of postoperation recovery, sedation score, visual analog scale （VAS）, postoperation analgesic requirement, and adverse events were recorded for 24 h after operation. Results Significantly lower VAS was observed in group T at 0.5, 1, 2, 6 h after operation compared with those in group K （P 〈 0.05） ; 6 hours after operation the VAS score in group T was significantly lower than that in group F （P〈 0.05）. The incidence of supplementary analgesics requirement in group T（ 10 % ） was lower than those in group K （ 60 % ） and group F （ 33 %, P 〈 0.05 ） ; the incidence of postoperative nausea and vomiting （PONV） in group T （60 % ） was higher than those in group K （27 % ） and group F （20 %, P % 0.05）. Conclusion Preemptive analgesia with tramadol is more effective than ketamine and fentanyl after gynecologic laparoscopic surgery, but the incidence of PONV is higher.

关 键 词：氯胺酮 曲马多 芬太尼 腹腔镜手术 超前镇痛 

分 类 号：R614[医药卫生—麻醉学]