曲马多用于全麻苏醒期镇痛的临床回顾性观察

CLINICAL RETROSPECTIVE OBSERVATION OF TRAMADOL FOR ANALGESIA DURING RECOVERY PERIOD OF GENERAL ANESTHESIA

摘要:

目的：对全身麻醉苏醒期静脉单次使用曲马多100g镇痛导致呕吐的高危因素进行分析,为曲马多合理应用提供参考。方法：回归性分析我院2017年10月至2019年4月期间476例麻醉苏醒期静脉单次使用曲马多镇痛的临床资料,对其年龄、性别、BMI、手术类型、麻醉维持方式、手术时间、失血量、输液量、曲马多苏醒前与苏醒后给药、曲马多给药速度快慢与曲马多用药后呕吐采用胃复安补救治疗的相关性进行分析,探讨麻醉苏醒期静脉单次给予曲马多100mg后发生呕吐的高危因素。结果：476例患者使用曲马多,294例快速给药30例出现呕吐,182例慢速给药3例出现呕吐(10.2% vs 1.65%,P = 0.000)；297例全麻苏醒前给药,苏醒后8例出现呕吐,179例全麻苏醒后给药,25例出现呕吐(2.7% vs 14.0%,P = 0.000)；二元Logistic 回归分析显示,曲马多苏醒后给药(OR = 5.204, P = 0.000)、曲马多快速给药(OR = 4.485, P = 0.025),是曲马多100mg单次静脉给药后发生呕吐的独立危险因素。结论：全麻苏醒前静脉慢速给予曲马多,可明显降低曲马多致呕吐发生率。

Abstract:

Objective: To analyze the high-risk factors of vomiting caused by single intravenous tramadol 100g analgesia during the recovery period of general anesthesia, so as to provide reference for rational use of tramadol. Methods: Clinical data of 476 cases of intravenous tramadol analgesia during anesthesia recovery period from October 2017 to April 2019 were analyzed retrospectively. The correlation between the age, sex, BMI, type of operation, methods of anesthesia maintenance, operation time, blood loss, infusion volume, tramadol administration before/after awakening, the speed of tramadol administration and the incidence of vomiting treatment with metoclopramide after tramadol intravenous administration were analyzed. The high-risk factors of vomiting after single intravenous administration of tramadol 100 mg during anesthesia recovery period were explored. Results: 476 patients used tramadol, 294 patients intravenous administration tramadol fast, 30 patients vomited, 182 patients administration slowly, 3 patients vomited (10.2% vs 1.65%, P = 0.000); 297 patients acceptted tramadol before awakening, 8 patients vomited after awakening, 179 patients acceptted tramadol after awakening, 25 patients vomited (2.7% vs 14.0%, P = 0.000); Binary logistic regression analysis showed that administration of tramadol after awakening (OR = 5.204, P = 0.000) and rapid administration of tramadol (OR = 4.485, P = 0.025) were independent risk factors for vomiting after single intravenous administration of tramadol. Conclusion: Slow intravenous administration of tramadol before general anesthesia recovery can significantly reduce the incidence of vomiting caused by tramadol.