术前口服曲马多缓释剂对瑞芬太尼复合麻醉病人术后急性阿片类药物耐受的影响  

Effect of preoperative administration of tramadol controlled release tablets on postoperative acute opioid tolerance in patients after remifentanil-based anesthesia

作　　者：吴城[1] 肖旺频[1] 程惠平[2] 姚明[1] 

机构地区：[1]浙江省嘉兴学院附属第二医院麻醉科,314000 [2]浙江省嘉兴学院医学院医学实验中心

出　　处：《中华麻醉学杂志》2010年第2期150-152,共3页Chinese Journal of Anesthesiology

基　　金：嘉兴市科技计划项目（2007AY2029）

摘　　要：目的评价术前口服曲马多缓释剂对靶控输注瑞芬太尼复合麻醉病人术后急性阿片类药物耐受的影响。方法择期拟行腹腔镜胆囊切除术病人60例，ASAⅠ或Ⅱ级，年龄18～64岁，随机分为2组（n=30）：安慰剂组（C组）和曲马多组（T组）。C组于术前48、36、24、12、0．5h时口服维生素C片1片（100mg），T组于相同时点口服曲马多缓释片1片（100mg），共计500mg。两组均采用靶控输注瑞芬太尼和异丙酚复合麻醉，拔除气管导管后在麻醉恢复室（PACU）观察1h送返病房。PACU内静脉注射芬太尼5～10μg，5min后重复注射，维持VAS评分〈4分。病房内采用10μg/ml芬太尼100ml行PCIA（负荷量10μg、背景输注速率20μg／h、PCA剂量5μg、锁定时间15min）。记录PACU内芬太尼用量、术后48h内PCIA芬太尼用量、有效按压次数（D1）和实际按压次数（D2），计算D1／D2比值。结果与C组比较，T组术后PACU内芬太尼用量减少（P〈0．05），术后48h内PCIA芬太尼用量和D1／D2比值差异无统计学意义（P〉0．05）。结论术前口服500mg曲马多缓释剂可减轻靶控输注瑞芬太尼复合麻醉病人术后急性阿片类药物耐受。Objective To investigate the effect of preoperative administration of tramadol controlled release tablets on postoperative acute opioid tolerance in patients after remifentanil-based anesthesia. Methods Sixty ASA Ⅰ or Ⅱ patients aged 18-64 yr undergoing laparoscopic cholecystectomy （LC） under general anesthesia were randomly divided into 2 groups （ n = 30 each） ： placebo control group （group C） and tramadol controlled release tablets group （group T）. In group C vitamin C tablets 100 mg was taken orally 48,36,24,12,0.5 h before operation and in group T tramadol controlled release tablets 100 mg was administered orally at the same time points respectively. Anesthesia was induced and maintained with TCI of remifentanil （Cp 1.5-6.0 ng/ml） and propofol （Cp 2.5-4.5 μg/ml）. The patients were observed in PACU for 1 h after LC and then transferred to the ward. Postoperative pain was controlled by intermittent iv boluses of fentanyl in PACU. Patient-controlled intravenous analgesia （PCIA） with fentanyl （loading dose 10 μg, background infusion 20 μg/h, bolus dose 5μg, lockout interval 15 min） was used in the ward. Fentanyl consumption in PACU during the first hour after operation was recorded. Fentanyl consumption of PCIA, the number of successful delivered doses （ D1 ） and the number of attempts （D2 ） in the ward during the 48 h after operation were recorded. D1/D2 ratio was calculated. Results Fentanyl consumption was significantly lower in group T than in group C during the first hour after operation in PACU （ P 〈 0.05）. There was no significant difference in fentanyl consumption of PCIA and D1/D2 ratio during the 48 h after operation between the two groups （P 〉 0.05 ）. Conclusion Preoperative administration of tramadol controlled release tablets （500 mg） can effectively alleviate early postoperative acute opioid tolerance induced by remifentanil-based anesthesia.

关 键 词：曲马朵 迟效制剂 投药 口服 哌啶类 药物耐受性 

分 类 号：R614[医药卫生—麻醉学]