摘要
目的观察曲马多不同给药方案对患儿扁桃体切除术后48h内疼痛和躁动的影响。方法择期扁桃体切除术患儿212例,男136例,女76例,年龄3~6岁,ASAⅠ或Ⅱ级,采用随机数字表法分为七组：A组（n=31）,曲马多2mg/kg＋0.2mg·kg-1·h-1泵注;B组（n=29）,曲马多2mg/kg＋0.1mg·kg-1·h-1泵注;C组（n=32）,曲马多1mg/kg＋0.2mg·kg-1·h-1泵注;D组（n=29）,曲马多1mg/kg＋0.1mg·kg-1·h-1泵注;E组（n=29）,生理盐水10ml＋曲马多0.2mg·kg-1·h-1泵注;F组（n=31）,生理盐水10ml＋曲马多0.1mg·kg-1·h-1泵注;以上所有持续静脉注射药物均为2ml/h;N组（n=31）,生理盐水10ml＋生理盐水2ml/h泵注。各组手术结束时刻均采用1ml 1%的利多卡因于双侧扁桃体窝内局部注射。记录拔管时间,清醒时间,以及清醒后10、30、60、120min的Ramsay评分,术后10、30、60、120min和4、8、24、32、48h的FLACC镇痛评分,以及4、8、12、24、32、40、48h的PCIA每时间段自控按压次数,呕吐发生次数,及以上各时间段的曲马多用量。结果七组患儿的拔管时间、清醒时间、呕吐发生率差异无统计学意义。A、B、C组在清醒后30min,D、E组在60min,而F、N组在90min后达到镇静满意（Ramsay评分2~4分）。A、B组在术后10min之后FLACC评分降低至4分以下,C组则在术后10、30min FLACC评分高于A、B组,D、E组在术后10、30、60、120min及4h疼痛评分高于A、B组,而F组在术后10、30、60、120min及4、8、24h疼痛评分始终高于A、B、C、D组,术后8、24、32、48h疼痛评分始终高于E组。N组术后10、30、60、120min及4、8、24、32、48h疼痛评分始终高于A、B、C、D、E组,术后4、8、24、32、48h疼痛评分始终高于F组（P〈0.05）。曲马多用量各时间段内,B组患儿均低于其他各组（P〈0.05）,A组患儿在12h内低于C、D、E、F组,12h后高于D、F组（P〈0.05）。C、D组在8h内均低于E、F两组（P〈0.05）,F组在8~12h高于E组,但12h后低于E组（P〈0.05
Objective To observe the effect of tramadol on pain and emergence agitation（EA）after tonsillectomy of children patients.Methods A total of 212patients（male 136 cases,female 76 cases,aged 3-6years,ASA Ⅰ orⅡ grade）undergoing elective tonsillectomy were divided into seven groups randomly：group A,31 cases,tramadol 2mg/kg bolus postoperative intravenous injection followed by continuous infusion of 0.2mg·kg-1·h-1;group B,29 cases,tramadol 2mg/kg bolus followed by continuous infusion of 0.2 mg·kg-1·h-1;group C,32 cases,tramadol 1 mg/kg bolus followed by continuous infusion of 0.2mg·kg-1·h-1;group D,29 cases,tramadol 1mg/kg bolus followed by continuous infusion of 0.1mg·kg-1·h-1;group E,29 cases normal saline 10 ml bolus followed by tramadol continuous infusion of 0.2mg·kg-1·h-1;group F,31 cases,normal saline 10 ml bolus followed by tramadol continuous infusion of 0.1mg·kg-1·h-1;group N,31 cases,normal saline 10 ml bolus followed by continuous infusion of 2ml/L.All patients received 1% Lidocaine 1ml injection to bilateral tonsilla fossa.Extubation time,awake time,Ramsay score 10,30,60,120 min after awake,FLACC pain score 10,30,60,120 min,4,8,24,32,48 hafter awake,and PCIA（patient contral intravenous analgesia）times in 4,8,12,16,24,32,40,48 h,and tramadol total dosage in all time points were recorded.Results No statistical significance in extubation time,awake time and vomiting rate between all groups.No longer EA was found in 30 min after awake in group A,B and C;in 60 min in group D and E;in 90 min in group F and N.FLACC scores in group A was lower than in group B（P〈0.05）and both were decreased to 4or less in 10 min after tonsillectomy.FLACC scores in group A and B were lower than group C within 30 min after operation;lower than group D and E in 10、30、60、120min and 4hafter operation.FLACC scores in group F were higher than in group A,B,C and D in 10、30、60、120min and 4、8、24hafter operation;higher than in group E in 8、24、32、48hafter operation.Pain scores in group N
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2015年第10期984-988,共5页
Journal of Clinical Anesthesiology
关键词
患儿
术后疼痛
术后躁动
扁桃体切除术
曲马多
Children patients
Postoperative pain
Emergence agitation
Tonsillectomy
Tramadol
