曲马多与吗啡PCIA用于老年人术后镇痛的比较

Comparison of the Effects of Postoperative Patients Controlled Analgesia of Morphine with Tramadol in Elder

目的 观察老年患者上腹部手术后应用曲马多与吗啡PCIA的镇痛效果及并发症。方法 选择实施上腹部手术的老年患者 4 0例 ,均在气管插管静吸复合全麻下手术。术毕清醒拔管 ,均选择负荷剂量 +持续剂量 +PCA给药模式行PCIA术后镇痛。 4 0例患者随机分为两组 ,即曲马多PCIA组 (T组 )和吗啡PCIA组 (M组 ) ,每组 2 0例。采用视觉模拟评分 (VAS)法行疼痛评分 ,并观察术后恶心呕吐、瘙痒、嗜睡、呼吸抑制等并发症的发生情况。结果 两组 2 4h的VAS疼痛评分差异无显著性 ;吗啡组尿潴留、呼吸抑制等不良反应高于曲马多组。结论 曲马多PCIA镇痛效果确切 ,呼吸抑制等副作用小 ,更适用于老年患者的术后镇痛。

Objective To compare the effects and safety of postoperative patient controlled intravenous analgesia(PCIA) of morphine with tramadol in elderly patients undergoing upper abdominal surgery.Methods Forty ASA Ⅰ～Ⅲ postoperative patients aged 70～83 years undergoing selective abdominal operation were randomly allocated into two groups(n=20):M group and T group.All patients initially received 0.5mg/kg bolus dosage of tramadol before administrating analgesia.Then 25mg of morphine diluted with 100ml of 0.9% NaCl was infused with PCA infuser(lockout=15min,PCA=0.5ml) by patients accompanied by continuous background infusion with a rate of 2ml in M group for 24 hours after operation,while 400mg of tramadol was done in T group.quality of postoperative analgesia was assessed by visual analogue scale(VAS) on postoperative four time-points(4h,8h,12h,24h).Side effects such as severe sedation,respiratory depression,vomiting and hypotension were observed for 24 hours after operation.Results The quality of postoperative analgesia was similar in both groups.However,a significant decreasing of respiratory depression in T group.Conclusions Tramadol PCIA is a safe and effective postoperative analgesia method for elder patients.