小剂量曲马多治疗硬膜外分娩镇痛时寒战的临床观察

摘要

目的 观察小剂量曲马多治疗产妇硬膜外分娩镇痛时寒战的效果.方法 120例行硬膜外分娩镇痛后发生寒战产妇,随机数字表法分为4组,每组30例,即C组(生理盐水组),T1组(曲马多0.25 mg·kg-1组),T2组(曲马多0.5 mg·kg-1组),T3组(曲马多1 mg·kg-1组),分别在硬膜外分娩镇痛发生寒战后给予生理盐水10 mL,曲马多0.25、0.5、1 mg·kg-1,均稀释到10 mL,注药时间均为1 min.记录硬膜外给药前(t0),以及给药后5 min(t1)、10 min(t2)、20 min(t3)、30 min(t4)时的血压(BP)、心率(HR)及血氧饱和度(SpO2),观察静脉给药15 min后产妇寒战、恶心、呕吐的发生情况,以及新生儿的Apgar评分、脐动脉血pH.结果 各组组间比较各时间点BP、HR及SpO2差异无统计学意义;各组组内比较,t2、t3、t4、t5 BP低于t0、t1 (P<0.05).静脉给药后T1组寒战例数明显低于对照组C组(P<0.05),T2组和T3组产妇寒战的发生率低于T1组(P<0.05);T3组产妇恶心的发生率高于其他三组(P<0.05).新生儿的1、5 min Apgar评分以及脐动脉血pH差异无统计学意义.结论 0.5 mg·kg-1曲马多治疗产妇在硬膜外分娩镇痛时寒战的效果确切、可靠,不会引起明显的恶心、呕吐.%Objective To evaluate the effect of low dose tramadol on treating shivering during epidural labor analgesia.Methods In this randomized double-blind placebo-controlled clinical trial,120 parturients whose shivering occurred during epidural labor analgesia were included.The patients were randomly assigned into 4 groups with 30 in each:control group,group T1,group T2 and group T3.0.9% normal saline was given to the control group,tramadol 0.25,0.5,and 1 mg·kg-1 were given to groups T1,T2 and T3 intravenously when shivering during epidural labor analgesia,respectively.All drugs were diluted to 10 ml and injection time was 1 minute.BP,HR,SpO2 were recorded before (t0) and 5 min(t1),10 min (t2),20 min (t3),30 min (t4) after the treatment of epidural,and intravenous dosing 15 min after the occurrence of maternal shivering,nausea,vomiting,the Apgar scores of the newborns,and the umbilical artery blood pH were observed.Results There were no differences in BP,HR,and SpO2among all groups at any time point.BP at t2,t3,t4 and t5 were lower than t0 and t1 in all groups (P<0.05).The incidence of shivering in group T1 was significantly lower than the control group and groups T2 and T3 were significantly lower than group T1(P<0.05).The incidence of nausea in the group T3 was significantly higher than the other three groups (P<0.05).1,5 min Apgar scores of the newborns,and umbilical artery blood pH had no significant differences among all groups.Conclusions 0.5 mg·kg-1 tramadol can effectively and reliablely treat maternal shivering during epidural labor analgesia without significant nausea and vomiting.