曲马多用于术后PCIA的临床对比研究

Comparative Clinical Study on Patient Controlled Intravenous Analgesia with Tramadol for Relief of Postoperative Pain

【目的】观察曲马多病人静脉自控镇痛 (PCIA)术后镇痛的临床效应 ,评定曲马多用于PCIA的恶心、呕吐等不良反应发生率以及在呼吸循环方面的安全性 ,为临床PCIA用药选择提供依据。【方法】择期手术病人 6 0例随机分为两组 :Ⅰ组曲马多组 (n =30 ) ,镇痛药为曲马多 80 0mg +氟哌利多 5mg +生理盐水至10 0ml;Ⅱ组吗啡组 (n =30 )镇痛药为吗啡 4 0mg +氟哌利多 5mg +0 .9%生理盐水至 10 0ml。PCIA选择负荷剂量 +维持剂量 +PCIA给药模式 (持续注射 2ml/h ,PCA剂量 0 .5ml/15min)。镇痛时间为术后 4 8h ,术后 4、8、12、2 4、4 8h随访并记录血压、脉搏、呼吸及药物用量、疼痛评分、恶心呕吐、皮肤瘙痒等情况。【结果】两组镇痛效果差异无显著性 (P >0 .0 5 ) ,曲马多组不良反应低于吗啡组。【结论】曲马多用于术后PCIA静脉镇痛是可行的。

To observe the clinical efficacy of patient controlled intravenous analgesia (PCIA) with tramadol for relief of postoperative pain and to evaluate its occurrence rate of adverse reactions ( such as nausea and vomiting) and cardiorespiratory safety for providing basis of drug selection during PCIA. Sixty postoperative patients were randomly divided into two groups:①Group Ⅰ(n=30): using 800mg tramadol plus 5mg droperidol diluted to 100 ml with normal saline; ②Group Ⅱ(n=30): using 40mg morphine plus 5mg droperidol diluted to 100 ml with normal saline. The model of administration was loading dose plus maintaining dose subjected to PCIA (2 ml/h, 0.5 ml/15 min). PCIA was kept for 48 hours. Patients were visited 4, 8, 12, 24, and 48 hours after operation , their blood pressure, pulse rate, respiratory rate, dosage of drugs, pain scores and adverse effects such as nausea, vomiting, pruritus, etc,were recorded. There were no statistically significant differences in analgesic efficacy between tramadol and morphine groups (P>0.05), but the adverse effects in the former were less than those in the latter.[Conclusion]Tramadol PCIA is safe and acceptable for relief of postoperative pain.