超前应用曲马多联合小剂量芬太尼防治全麻苏醒期躁动的临床观察

摘要

目的 探讨超前应用曲马多联合小剂量芬太尼防治全麻苏醒期躁动的临床效果.方法 选择80例择期在全身麻醉下行腹腔镜胆囊切除术患者,采用随机数字表法,将患者随机分为观察组和对照组,每组40例.对照组在胆囊切除后静脉注射曲马多1.5 mg/kg、芬太尼0.1 μg/kg,观察组在入室开放外周静脉后静脉注射曲马多1.5 mg/kg、芬太尼0.1 μg/kg,观察两组拔管前5 min(T1)、拔管时(T2)、拔管后5 min(T3)的MAP、HR变化和躁动评分(RS)、镇静评分(RSS),记录苏醒时间、拔管时间和拔管后10 min(T4)舒适度评分(BCS)变化.结果 T1、T2 MAP、HR明显低于对照组(P<0.05);T1、T2、T3观察组RS、RSS显著低于对照组(P<0.05),而T4时BCS明显高于对照组(P<0.05).观察组苏醒时间和拔管时间明显短于对照组(P<0.05).结论 超前应用曲马多联合小剂量芬太尼防治腹腔镜胆囊切除术全麻患者,其苏醒期躁动效果优于术毕前应用.%Objective To investigate the preemptive effects of tramadol combined with small dose fentanyl on preventing emergence agitation from general anesthesia. Methods 80 patients undergoing general anesthesia in laparo-scopic cholecystectomy were randomized into two groups by using a random number table, with 40 cases in each group. The control group were given intravenous injection of tramadol 1. 5mg/kg and fentanyl 0.1μg/kg after cholecystectomy, intravenous injection of tramadol 1. 5 mg/kg and fentanyl 0.1μg/kg were given when peripheral venous was break-open in the observation group. MAP,HR and agitation score( RS ),Ramsay sedation score( RSS )before extuba-tion 5 min( T1),extubation( T2 ),5 min after extubation( T3 )were observed. The recovery time,extubation time and ex-tubation after 10 min( T4 )Bruggrmann Comfort Scale( BCS )of the two groups were recorded. Results MAP,HR at T1 ,T2 in observation group were significantly lower than those in control group( P <0. 05 );RS,RSS at T1 ,T2 ,T3 in observation group were significantly lower than those in control group( P < 0. 05 ), while BCS at T4 was significantly higher than that in control group( P <0. 05 ). The recovery time and extubation time in observation group were significantly shorter than those in control group( P < 0. 05 ). Conclusion Combination of preemptive tramadol with small dose fentanyl has better effects on preventing emergence agitation from general anesthesia.