低剂量曲马多预处理对剖宫产术麻醉后寒战的影响  

Low dose of tramadol preconditioning preventing prophylaxis of shivering during subarachnoid anaesthesia for cesarean section： a randomized double-blind placebo-controlled clinical trial

作　　者：王晓宁[1] 刘丽[1] 汪润[1] 赵斌江[1] 冯艺[2] 

机构地区：[1]首都医科大学附属北京世纪坛医院麻醉科,100038 [2]北京大学人民医院麻醉科

出　　处：《中国医药》2012年第12期1578-1580,共3页China Medicine

摘　　要：目的观察低剂量曲马多预处理对剖宫产术蛛网膜下腔麻醉后寒战的预防作用。方法择期行剖宫产手术产妇90例，年龄21—43岁，美国麻醉医师协会分级I-Ⅱ级。采用随机数字表法将产妇随机分为对照组（蛛网膜下腔麻醉给药前30min静脉推注0．9％氯化钠注射液5ml，30例）、观察组A（蛛网膜下腔麻醉给药前30min静脉推注盐酸曲马多0．5mg／kg，30例）、观察组B（蛛网膜下腔麻醉给药前30min静脉推注盐酸曲马多1．0mg／kg，30例）。3组注药时间均为10s。记录麻醉开始至手术结束后6h内寒战、镇静、恶心、呕吐、眩晕、低血压、心动过缓、呼吸抑制等不良反应发生情况和新生儿的Apgar评分。结果对照组、观察组A和观察组B寒战发生率分别为40．0％（12／30）、13．3％（4／30）和10．0％（3／30），与对照组比较，观察组A和观察组B寒战发生率均较低，组间比较差异有统计学意义（P〈0．05），观察组A与观察组B问的差异无统计学意义（P〉0．05）。对照组、观察组A和观察组B镇静发生率分别为6．7％（2／30）、23．3％（7／30）、46．7％（妒／30），对照组和观察组A镇静发生率明显低于观察组B，组间差异有统计学意义（P〈0．05）。3组均未发生眩晕、过度镇静和呼吸抑制且术中低血压、心动过缓发生率组间差异无统计学意义（P〉0．05）。结论与曲马多1．0mg／kg相比，曲马多0．5mg／kg预处理能够有效地预防蛛网膜下腔麻醉后产妇的寒战反应，且不良反应发生率减低。Objective To evaluate the effect of low dose tramadol on prophylaxis of shivering during spinal anaesthesia. Methods In this prospective, randomized and double-blind study, 90 cases American society of anesthesiologists（ASA） I and II patients ranging 21-43 years old undergoing selective cesarean section were included. The patients were randomly allocated to the control group （0. 9% normal saline were given as an intravenous bolus 30 min before intrathecal injection, n = 30） ; observation group A（ tramadol 0.5 mg/kg were given as an intravenous bolus 30 min before intratheeal injection, n = 30 ） ; observation group B （tramadol 1.0 mg/kg were given as an intravenous bolus 30 min before intrathecal injection, n = 30）. All drugs were given as a bolus of 5 millilitres in 10 seconds. From the start of anaesthesia to 6 hours after surgery, the complications including shivering, oversedation, nausea, vomiting and dizziness; the Apgar scores of the newborns was observed. Results The incidence of shivering in the control group, observation group A and B was 40.0% （ 12/30）, 13.3% （4/30） and 10.0% （3/30） respectively. Compared with the control group, the incidence of shivering in both observation group A and B was significantly lower （ P 〈 0.05 ） ; no statistical difference was observed between observation group A and B. The incidences of sedation in the control group, observation group A and B were 6.7% （2/30） , 23.3% （7/30） and 46.7% （14/30） respectively. The incidence of sedation in the control group and observation group A was significantly lower than that in observation group B （ P 〈 0.05 ）. No dizziness, oversedation or respiratory depression was observed in three groups and there was no statistics difference in the incidences of hypotension and bradycardia among three groups （ P 〉 0.05 ）. Conclusions Compared with tramadol 1 mg/kg, preconditioning tramadol 0. 5mg/kg is als0 effective for prophylaxis of shivering during subaraehnoid anaesthesia in patients under

关 键 词：寒战 曲马多 麻醉前用药 区域麻醉 剖宫产术 

分 类 号：R714[医药卫生—妇产科学]