曲马多和罗比卡因用于硬膜外自控镇痛被引量：11

Postoperative patient-controlled epidural analgesia with tramadol or ropivacaine

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摘要目的　观察不同剂量的曲马多与 0 12 %的罗比卡因配伍用于术后病人硬膜外自控镇痛 (PCEA)的效果。方法　选择行全麻与硬膜外复合麻醉的腹部手术病人 4 5例 (ASAI～III级 )进行术后PCEA ,随机等分为三组 ,F组 :0 12 %罗比卡因 +芬太尼 2 μg/ml;A组 :0 12 %罗比卡因 +0 1%曲马多 ;B组 :0 12 %罗比卡因 +0 2 %曲马多。每组设置都为 4ml/h ,PCA为 2ml,锁定时间2 0min ,总量 2 5 0ml。记录 2 4h疼痛视觉模拟评分 (VAS ,0～ 10分 )、疼痛语言分级 (VRS ,4 -无痛 ,3-微痛 ,2 -较痛 ,1-剧痛 )、按压PCA次数 (PCAd)、PCA有效次数 (PCAe)、D/D比值 (PCAd/PCAe)、2 4h药量 (ml)及病人主观不适感。结果　三组总的术后镇痛效果无差异 ,优良率为 6 7%(30 / 4 5 ,VAS <3分 ) ,安静时无痛率 35 % (16 / 4 5 ,VRS =4 ) ,其中B组与A组比安静时无痛率有显著差异 (P <0 0 5 ) ,三组的恶心发生率F组 4 / 15 (2 7% ) ,A组 6 / 15 (40 % ) ,B组 10 / 15 (6 7% ) ,B组与F组比 ,有显著差异 (P <0 0 5 )。结论　 0 1%或 0 2 %曲马多复合 0 12 %罗比卡因用于腹部手术后PCEA(4ml/h)效果确切 ,以 0 2 %曲马多复合 0 12 %罗比卡因效果更好。 Objective To evaluate the efficacy of the postoperative patient controlled epidural analgesia (PCEA) with different doses of tramadol with 0 12% ropivacaine Methods 45 patients (ASA I Ш) undergoing general anesthesia combined with epidural block for abdominal procedures were randomly assigned to three PCEA groups( n= 15),group F was given 0 12% ropivacaine+2μg/ml fentanyl,group A was given 0 12% ropivacaine+0 1% tramadol,group B was given 0 12% ropivacaine+0 2% tramadol The analgesic device was programmed 4ml/h, 2ml on demand with a lockout time of 20min The total volume was 250ml The VAS,VRS(verbal rating scale),the number of PCA demand(PCA d) and PCA effect (PCA e), PCA d/PCA e ratio, the dose of analgesic during the first 24h and the side effects were recorded Results There were no differences between the three groups in the analgesia profile in the first 24h 67%(30/45)patients had satisfied analgesia(VAS<3)and 35%(16/45) patients had no pain at rest(VRS=4) in the three groups There were significant differences in VRS=4 ( P< 0 05) between group A and group B The incidence of nausea in group B(10/15,67%)were significantly increased compared with that in group F(4/15,27%)( P< 0 05), and not significantly increased compared with that in group A(6/15,40%) ( P> 0 05) Conclusions 0 1% or 0 2% tramadol combined with 0 12% ropivacaine can provide with a satisfied analgesia during PCEA after abdominal procedures The analgesia effects are better and the incidences of nausea are also higher with 0 2%tramadol PCEA

作者秦翔吴新民张生锁

机构地区北京大学第一医院麻醉科

出处《临床麻醉学杂志》 CAS CSCD 2003年第5期276-278,共3页 Journal of Clinical Anesthesiology

关键词曲马多罗比卡因硬膜外自控镇痛腹部手术不良反应 Patient controlled epidural analgesia Tramadol Ropivacaine

分类号 R614 [医药卫生—麻醉学]

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