微创医学

目的观察曲马多超前镇痛用于小儿腹腔镜手术的镇痛效果及安全性。方法择期行腹腔镜手术患儿90例,随机分为3组,每组30例,A组于麻醉后手术开始前,B组于麻醉拔管后缓慢静注曲马多2 mg/kg(用生理盐水稀释至5 mL),C组以生理盐水5 mL缓慢静注。注药时间均为1 min。观察术后1 h、2 h、4 h、8 h、12 h的疼痛评分及恶心呕吐、呼吸抑制等不良反应,观察拔管后60 min苏醒期躁动发生率。结果 A组、B组术后各时点疼痛评分明显低于C组,A组也明显低于B组(P<0.05);苏醒期A组、B组躁动发生率明显低于C组,前20 min A组也明显低于B组(P<0.05);3组术后呼吸抑制、恶心呕吐等不良反应发生率差异无统计学意义(P>0.05)。结论曲马多超前镇痛较术后应用能有效减轻腹腔镜手术患儿术后急性疼痛和苏醒期广西壮族自治区卫生厅科研课题(合同号:Z2010104)

Objective To investigate the safety and efficacy of tramadol preemptive analgesia in children undergoing laparoscope operation． Methods 90 children undergoing laparoscope operation were randomly divided into three groups． The patients in group A received tramadol injection at 2 mg /kg dosage after anesthesia before operation ( diluted the drug to 5 ml with normal saline) ． The patients in group B received the same dosage after removal tracheal catheter． The patients in group C received 5 ml normal saline as control． Pain scores，respiratory depression，nausea and vomiting were observed at 1，2 ，4 ，8 ， and 12 h after operation． The incidence of delirium were observed at 10，20，30，40，50，and 60 min of revive period． Results Pain scores in group A and in group B at all time points were significantly lower than those in group C( P ＜ 0． 05) ． Pain scores in group A at all time points were significantly lower than those in group B( P ＜ 0． 05) ． The incidence of delirium in group A and in group B at all time points were significantly lower than those in group C( P ＜ 0． 05) ． The incidence of delirium in group A at 20 min before revive points were significantly lower than those in group B( P ＜ 0． 05) ． There were no difference in the incidence of respiratory depression，postoperative nausea or vomiting among three groups( P ＞ 0． 05) ． Conclusion Compared with postoperative application， preemptive tramadol injection can more effectively reduce postoperative acute pain and delirium during analepsia without apparent side effect，indicating its safety in postoperative analgesia in children．