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中华胃食管反流病电子杂志 ›› 2017, Vol. 04 ›› Issue (04) : 148 -152. doi: 10.3877/cma.j.issn.1674-6899.2017.04.002

所属专题: 文献

论著

曲马多超前镇痛对腹腔镜食管裂孔疝修补术拔除气管插管期应激反应的有效性研究
张雪蓉1, 秦建华, 马庆军1,()   
  1. 1. 830001 乌鲁木齐,新疆维吾尔自治区人民医院麻醉科
  • 收稿日期:2017-10-24 出版日期:2017-11-15
  • 通信作者: 马庆军
  • 基金资助:
    新疆维吾尔自治区人民医院科技创新项目(20150123)

Preemptive analgesia effects of tramadol on stress reaction during extubation in patients undergoing laparoscopic hiatus hernia surgery

Xuerong Zhang1, Jianhua Qin, Qingjun Ma1,()   

  1. 1. Department of Anesthesiology, Xinjang Uygur Autonomous Region People′s Hospital, Urumqi 830001, China
  • Received:2017-10-24 Published:2017-11-15
  • Corresponding author: Qingjun Ma
  • About author:
    Corresponding author: Ma qingjun, Email: Email:
引用本文:

张雪蓉, 秦建华, 马庆军. 曲马多超前镇痛对腹腔镜食管裂孔疝修补术拔除气管插管期应激反应的有效性研究[J/OL]. 中华胃食管反流病电子杂志, 2017, 04(04): 148-152.

Xuerong Zhang, Jianhua Qin, Qingjun Ma. Preemptive analgesia effects of tramadol on stress reaction during extubation in patients undergoing laparoscopic hiatus hernia surgery[J/OL]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2017, 04(04): 148-152.

目的

评价曲马多超前镇痛对腹腔镜食管裂孔山修补术拔除气管插管期应激反应的有效性。

方法

前瞻性分析2016年6月至2016年12月,新疆维吾尔自治区人民医院60例择期行腹腔镜食管裂孔疝修补术的患者临床资料,行随机双盲对照试验,计算机随机化分为3组,每组20例,曲马多超前镇痛组(A组):术前30 min静脉注射曲马多2.5 mg/kg,手术结束缝合皮肤时静脉注射生理盐水2 ml;曲马多术后镇痛组(B组):术前30 min静脉注射生理盐水2 ml,手术结束缝合皮肤时静脉注射曲马多2.5 mg/kg;对照组(C组):术前30 min及手术结束缝合皮肤时均静脉注射2 ml生理盐水。记录给药前、手术结束缝合皮肤时、拔除气管导管时患者的平均动脉压(MAP)、心率(HR)和氧饱和度(SpO2),并抽取静脉血测定三组患者用药前、手术结束时、拔除气管插管时血浆皮质醇和血糖浓度,在患者拔除气管导管后即刻对其疼痛程度进行VAS疼痛评分,并观察患者术后24 h内是否出现头晕、恶心呕吐、尿潴留和皮肤瘙痒等情况。

结果

A、B组在拔除气管插管时HR、MAP均低于C组,A组在拔除气管插管时HR、MAP低于B组,差异均有统计学意义(P<0.05);在手术结束缝皮时及拔除气管插管时,A、B组血浆皮质醇和血糖浓度均低于C组,A组血浆皮质醇和血糖浓度低于B组,差异均有统计学意义(P<0.05);拔除气管插管后即刻,A、B组的VAS疼痛评分均显著低于C组,A组VAS疼痛评分又低于B组,差异均有统计学意义(P<0.05)。

结论

术前预先静脉注射曲马多更能够有效减少腹腔镜食管裂孔疝修补术患者拔除气管导管期间的应激反应,发挥很好的镇痛作用,其机制可能与超前镇痛相关。

Objective

To investigate the preemptive analgesia effects of tramadol on stress reaction during in patients undergoing laparoscopic hiatus hernia surgery.

Methods

Conduct prospective studying sixty patients undergoing laparoscopic hiatus hernia surgery of Xinjang Uygur Autonomous Region People′s Hospital from June to December 2016.All the patients were randomly divided into three groups with 20 each by double-blind design method.Tramadol preemptive analgesia group(group A): received tramadol 2.5 mg/kg intravenously 30 min before operation and 2 ml saline at the end of operation; Tramadol postoperative analgesia group(group B): received 2 ml saline 30 min before operation and tramadol 2.5 mg/kg intravenously at the end of surgery; Control group(group C): injected 2 ml saline 30 min before surgery and at the end of operation surgery.The patient′s mean arterial pressure(MAP), heart rate(HR), oxygen saturation(SpO2), plasma cortisol and blood sugar levels were recorded and compared before injection, at the end of surgery and during extubation.After the extubation visual analogue scale(VAS)for pain was measured and observed the occurrence of nausea, vomiting, uroschesis and skin pruritus.

Results

MAP and HR were significantly lower in group A and B than those in group C, while group A lower than B during extubation and at the end of operation(P<0.05). Blood glucose and cortisone in group A and B were significantly lower than those in group C, while group A is more slower than group B at the end of surgery and during extubation(P<0.05). VAS scores in group A and B were significantly lower than those in group C during extubation(P<0.05)but group A lower than group B(P<0.05).

Conclusion

Tramadol preoperative injection can reduce stress reaction during extubation and play good effect on analgesia.The mechanism may be related to preemptive analgesia.

表1 3组患者一般资料比较(±s)
表2 3组患者不同时点的MAP、HR、SpO2比较(±s)
表3 3组患者不同时点血浆皮质醇和血糖浓度(±s)
表4 3组患者拔除气管插管后VAS评分(分,±s)
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