Mildh L H, Leino K A, Kirvelä O A
Department of Anesthesia, Helsinki University Hospital, Finland.
J Clin Anesth. 1999 Jun;11(4):310-6. doi: 10.1016/s0952-8180(99)00047-1.
To evaluate the effects of high analgesic doses of tramadol and meperidine on respiration, plasma catecholamine concentrations, and hemodynamic parameters.
Randomized, double-blind, cross-over, controlled volunteer study.
Laboratory at a university hospital.
8 healthy male volunteers.
Tramadol was given as a 150 mg bolus plus a succeeding 3-hour steady infusion of 250 mg (83.3 mg/hr). Meperidine was given in a similar manner as a bolus dose of 112.5 mg plus 187.5 mg in a 3-hour steady infusion (62.5 mg/hr). Experimental pain was induced using a tourniquet.
Respiration was studied noninvasively with respiratory inductive plethysmography and pulse oximetry. Arterial line was used for measurement of hemodynamics and blood sampling. Tramadol did not have any clinically significant effects on respiration, breathing pattern, or hemodynamics, but an increase in plasma epinephrine levels was noted. Meperidine bolus decreased tidal volume (p < 0.05, difference from baseline) and pulse oxygen saturation (from 97% to 94%, p < 0.05), but during the succeeding infusion, the respiratory drive, measured as mean inspiratory flow, was enhanced (p < 0.05 difference from baseline), and the respiratory parameters returned to baseline level. No change in hemodynamics was noted, but a significant increase in plasma norepinephrine and epinephrine levels (from 0.9 to 1.6 nmol/L and from 0.3 to 0.8 nmol/L, respectively; p < 0.05) was observed after meperidine administration. Tramadol caused nausea more often than meperidine (p < 0.05, between treatments).
Tramadol exhibited a minimal effect on respiration and breathing pattern in healthy volunteers. The respiratory effects of meperidine bolus were predictable with decreasing tidal volume and pulse oxygen saturation. In contrast, during meperidine infusion, adequate respiration was preserved despite the large amount of meperidine infused.
评估高镇痛剂量曲马多和哌替啶对呼吸、血浆儿茶酚胺浓度及血流动力学参数的影响。
随机、双盲、交叉、对照志愿者研究。
大学医院实验室。
8名健康男性志愿者。
曲马多以150mg推注给药，随后3小时持续输注250mg（83.3mg/小时）。哌替啶给药方式类似，推注剂量为112.5mg，3小时持续输注187.5mg（62.5mg/小时）。使用止血带诱发实验性疼痛。
采用呼吸感应体积描记法和脉搏血氧饱和度测定法对呼吸进行无创研究。通过动脉留置导管测量血流动力学并采集血样。曲马多对呼吸、呼吸模式或血流动力学无任何具有临床意义的影响，但血浆肾上腺素水平有所升高。哌替啶推注使潮气量降低（p<0.05，与基线相比有差异），脉搏血氧饱和度从97%降至94%（p<0.05），但在随后的输注过程中，以平均吸气流量衡量的呼吸驱动力增强（与基线相比p<0.05有差异），呼吸参数恢复至基线水平。血流动力学无变化，但哌替啶给药后血浆去甲肾上腺素和肾上腺素水平显著升高（分别从0.9nmol/L升至1.6nmol/L和从0.3nmol/L升至0.8nmol/L；p<0.05）。曲马多引起恶心的频率高于哌替啶（治疗组间p<0.05）。
曲马多对健康志愿者的呼吸和呼吸模式影响极小。哌替啶推注的呼吸效应表现为潮气量和脉搏血氧饱和度降低，具有可预测性。相比之下，在哌替啶输注过程中，尽管输注了大量哌替啶，但仍能维持足够的呼吸。
