de Witte J, Deloof T, de Veylder J, Housmans P R
Department of Anesthesiology and Critical Care Medicine, OLV-Clinic, Aalst, Belgium.
Acta Anaesthesiol Scand. 1997 Apr;41(4):506-10. doi: 10.1111/j.1399-6576.1997.tb04732.x.
As an inhibitor of the reuptake of serotonin and norepinephrine in the spinal cord, the mechanism of action of tramadol resembles that of nefopam, which has been used in the treatment of postanesthetic shivering.
In a randomized, placebo-controlled, double-blind study, we assessed the effects of tramadol (0.5 mg.kg-1, 1 mg.kg-1 and 2 mg.kg-1 i.v.) or normal saline on shivering after a standardized general anesthesia in 40 adult patients, ASA physical status I or II (group 1), and in 64 adult patients regardless of the foregoing general anesthesia and ASA physical status (group 2).
Tramadol 1 mg.kg-1 or more abolished shivering completely 5 min after treatment in all patients of groups 1 and 2. In group 1, the three dosages of tramadol were not statistically different in lowering the severity and prevalence of postanesthetic shivering. Tramadol 0.5 mg.kg-1 was significantly slower than tramadol 1 or 2 mg.kg-1 in tempering the severity as well as lowering the prevalence of postanesthetic shivering in group 2.
Tramadol's distinct features in the treatment of shivering reside in its high safety profile and weak sedative properties, particularly in patients with poor cardiorespiratory reserve, in outpatients and on recurrence of shivering.
作为脊髓中5-羟色胺和去甲肾上腺素再摄取的抑制剂，曲马多的作用机制类似于奈福泮，后者已用于治疗麻醉后寒战。
在一项随机、安慰剂对照、双盲研究中，我们评估了曲马多（0.5mg·kg-1、1mg·kg-1和2mg·kg-1静脉注射）或生理盐水对40例ASA身体状况为I或II级的成年患者（第1组）以及64例成年患者（无论上述全身麻醉和ASA身体状况如何，第2组）在标准化全身麻醉后寒战的影响。
第1组和第2组的所有患者在接受1mg·kg-1或更高剂量曲马多治疗5分钟后寒战完全消失。在第1组中，三种剂量的曲马多在降低麻醉后寒战的严重程度和发生率方面无统计学差异。在第2组中，0.5mg·kg-1曲马多在减轻麻醉后寒战的严重程度以及降低其发生率方面明显慢于1mg·kg-1或2mg·kg-1曲马多。
曲马多在治疗寒战方面的独特之处在于其高安全性和弱镇静特性，特别是在心肺储备功能差的患者、门诊患者以及寒战复发时。
