曲马多联合格拉司琼治疗椎管内麻醉患者术中寒战的临床观察.docVIP

曲马多联合格拉司琼治疗椎管内麻醉患者术中寒战的临床观察 [摘要] 目的 观察曲马多联合格拉司琼治疗椎管内麻醉患者寒战的临床疗效。 方法 将在椎管内麻醉术中出现寒战的120例患者分为三组，各40例。ⅰ组予曲马多1mg/kg联合格拉司琼3mg治疗，ⅱ组予曲马多1mg/kg治疗，ⅲ组予物理保温。观察三组用药后治疗效果。结果 ⅰ组和ⅱ组寒战治疗有效率均大于ⅲ组，ⅰ组和ⅱ组寒战治疗有效率比较差异无显著性。ⅱ组恶心、呕吐发生率明显高于ⅰ组和ⅲ组，ⅰ组和ⅲ组比较差异无显著性。结论 曲马多联合格拉司琼治疗椎管内麻醉寒战安全有效，而且可以有效防治患者恶心呕吐。 [关键词] 曲马多；格拉司琼；椎管内麻醉；寒战 [中图分类号] r614 [文献标识码] b [文章编号] 1673-9701（2011）36-154-02 clinical observation on tramadol combined granisetron joan treatment of intraspinal anesthesia in patients with shiver wei zhonghai jilin province panshi city hospital，panshi 132300，china [abstract] objective to observe the tramadol combined with granisetron joan treatment patients undergoing intravertebral anesthesia shivering clinical curative effect. methods in patients undergoing intravertebral anesthesia shivering during operation in 120 cases of patients were divided into three groups，40 cases each. group to tramadol 1mg/kg combined granisetron joan 3 mg treatment，group ii to tramadol 1mg/kg treatment， group iii to the physical insulation. three groups were observed after administration of therapeutic effect. results ⅰ group and ⅱ group therapy was shivering are larger than ⅲ group，ⅰ group and ⅱ group therapy was shivering is no significant differences. ⅱ group of nausea，vomiting rate was significantly higher than the ⅰ group and ⅲ group， ⅰ group and the group compared ⅲ no significant differences. conclusion tramadol combined granisetron joan treatment of intraspinal anesthesia shivering is safe and effective，but also can effectively prevent nausea and vomiting. [key words] tramadol；granisetron；spinal anesthesia；shivering 体温恒定是保证机体生理和代谢稳定的重要因素，围术期由于麻醉药对体温调节的抑制及患者缺乏应有的保温措施以及患者自身紧张因素等原因，患者往往伴有不同程度的寒战发生。寒战不仅使眼内压、颅内压升高，还可使氧耗及co2的产量增加，这种代谢的增加对肺内分流、心排出量固定、呼吸贮备降低的患者极其不利。故有效防治围术期寒战的发生是麻醉处理的关键措施之一，而椎管内麻醉寒战的发生率很高，不仅影响手术操作及临床监测，而且使患者肌体耗氧量增加。曲马多是新型的阿片受体弱激动药，属非麻醉性中枢镇痛药，其治疗寒战的机制可能与曲马多抑制脊髓中枢神经元去甲肾上腺素（ne）和5-羟色胺（5-ht）的重摄取，使得脊髓水平的突触小体ne和5-ht浓度增高有关，从而抑制寒战的发生。因曲马多对呼吸、循环影响小，可作为治疗围麻醉期寒战的良好选择。为防止曲马多引起的恶心、呕吐症状，故联合应用格拉司琼以减