利多卡因和曲马多对瑞芬太尼复合全身麻醉效果的影响  

Effect of lidocaine and tramadol on remifentanil combined general anesthesia

作　　者：王尔华[1] 徐洁[1] 戴黎敏[1] 马正良[1] 

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,210008

出　　处：《中国医师进修杂志》2010年第36期8-11,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 评估利多卡因和曲马多对瑞芬太尼复合全身麻醉效果的影响.方法 将80例在瑞芬太尼复合全身麻醉下行经腹子宫切除术患者按随机数字表法分为四组,每组20例.LT组：诱导时静脉输注利多卡因1 mg/kg,继以2 mg/（kg·h）持续泵注至手术结束,诱导时、手术结束前30min各静脉注射曲马多1.5 mg/kg;L组：单用利多卡因,方法同LT组;T组：单用曲马多,方法同LT组;对照组：以0.9%氯化钠替代.记录围手术期平均动脉压（MAP）、心率、躁动评分（RS）、Ramsay镇静评分（RSS）、视觉模拟评分（VAS）、拔管时间、药物使用情况、并发症等.结果 与其他三组比较,LT组手术期间普鲁泊福用量[（450±178）mg]少,拔管时间[（15.0±4.8）win]短,苏醒期间躁动发生率低、RSS高,在麻醉后加强监护病房（PACU）仅1例使用芬太尼,术后48 h内仅1例肌肉注射哌替啶;L组苏醒期间有RS高于、RSS低于、在PACU芬太尼使用例数多于、而术后48 h内肌肉注射哌替啶例数少于T组趋势.结论 围手术期使用利多卡因可较好地减轻术后疼痛,减少术后镇痛药用量,使用曲马多可降低瑞芬太尼复合全身麻醉苏醒期间的急性疼痛及躁动发生率,两者联用能取得更好的效果.Objective To evaluate the effect of lidocaine and tramadol on remifentanil combined general anesthesia. Methods Eighty patients undergoing abdominal hysterectomy were divided into group LT,L,T and C by random digits table,each with 20 cases .In group LT,during induction,the patients were intravenously. In group L,only used lidocaine as introduced in group LT. In group T,only used tramadol as shown in group LT. In group C,used the same volume of saline solution. The changes of mean arterial pressure （M A P） and heart rate during the operation, dysphoria grade （RS）, Ramsay score （RSS）, pain score （VAS）,extubation time（ET）,medication and dose,complications were recorded. Results In group LT,the dosage of propofol [（450 ± 178） mg] was less （P 〈 0.05）, ET [（15.0 ± 4.8） min] was shorter （P 〈 0.05）,during recovery time, RS was lower, RSS was higher,the cases needad fentanyl （1 case）, 48 h after operation, only 1 case needed pethidine to relieve pain was less than those in other groups （P 〈 0.05）. In group L there was a tend that its RS and the cases needed fentanyl and fentanyl dosage were more, RSS was less than those in group T during recovery time,but 48 h after operation,the cases needed pethidine was less than that in group T. Conclusions Using lidocaine during operation may relieve pain after operation, reduce the dosage of analgesic;giving tramadol may alleviate the acute pain and lower dysphoria incidence rate after remifentanil anesthesia. Combining them will get a better effect.

关 键 词：子宫切除术 利多卡因 曲马多 瑞芬太尼 

分 类 号：R614[医药卫生—麻醉学]