摘要
目的采用术后硬膜外患者自控镇痛(PCEA)对曲马多联合小剂量吗啡或芬太尼的镇痛效果进行研究。方法将120例接受PCEA的腹部手术患者(美国麻醉医师协会分级Ⅰ-Ⅱ级)随机分为3组。T组镇痛液为0．6％曲马多,TM组为0．4％曲马多和0．004％吗啡,TF组为0．4％曲马多和0．000 4％芬太尼。采用相同PCEA参数:持续输注量2 mL／h,单次自控给药量1 mL,锁定时间为20 min。结果TM组和TF组在镇痛早期(第4、8和24小时)视觉模拟评分法(VAS)评分明显低于T组(P值均<0．01);在镇痛终点(第48小时)3组间差异无显著性(P>0．05)。T组的PCEA按压次数和总用量明显高于TM组和TF组(P<0．01或<0．05)。TF组的不良反应如恶心、呕吐等的发生率明显少于T组和TM组(P值均<0．05)。TF组的患者总体满意度明显高于T组和TM组(P值均<0．05)。结论与单用曲马多相比,联合小剂量吗啡或芬太尼可取得更佳的镇痛效果,特别在镇痛早期。由于镇痛效果可靠和不良反应少,曲马多联合小剂量芬太尼是一种值得推荐的PCEA方法。
Objective To study the analgesic effect for postoperative patient-controlled epidural analgesia （PCEA） of tramadol combined with low-dose morphine or fentanyl. Methods One hundred twenty patients （ASA status Ⅰ - Ⅱ ） undergoing abdominal operation with PCEA were randomly allocated to three groups, forty for each. The analgesic solutions were 0.6% tramadol in Group T, 0.4% tramadol and 0. 004% morphine in Group TM, 0.4 % tramadol and 0. 000 4 % fentanyl in Group TF. The same LCP parameters were used in continuous infusion of 2 mL/h and a bolus dose of 1 mL with a lockout interval of 20 rain. Results In the early analgesic time （4, 8 and 24 h）, the VAS scores of Group TM and Group TF were lower than that of Group T with no significant differences in the analgesic end point （48 h）. The number of PCEA demanded and total dose of Group T were higher than those of Group TM and Group TF. Lower incidence of side effects such as nausea and vomiting occurred in Group TF. Comparing to Group T and Group TM, Group TF patients received the highest Global Satisfaction Score （GSS）. Conclusion Tramadol combined with low-dose morphine or fentanyl produces good quality of pain relief than tramadol alone, especially in the early analgesic stage. Tramadol combined with low-dose fentanyl was considered as a satisfactory method for PCEA with reliable analgesia and low incidence of side effects. （Shanghai MedJ, 2006, 29..718-720）
出处
《上海医学》
CAS
CSCD
北大核心
2006年第10期718-720,共3页
Shanghai Medical Journal
关键词
硬膜外患者自控镇痛
术后
曲马多
吗啡
芬太尼
Patient controlled epidural analgesia
Postoperative
Tramadol
Morphine
Fentanyl
