曲马多和芬太尼用于非体外循环冠状动脉搭桥术后镇痛的比较

Comparison of Analgesic Effects of Tramadol and Fentanyl Used for Patient-controlled Intravenous Analgesia After Off-pump Coronary Artery bypass Grafting

目的 :比较曲马多、芬太尼用于非体外循环冠状动脉搭桥术后病人静脉自控镇痛的镇痛效果及不良反应。方法 :36例非体外循环冠状动脉搭桥术后病人 ,随机分为两组 ,每组 18例 ,A组选用曲马多 80 0 m g+咪唑安定 10mg+昂丹司琼 4 m g,用生理盐水稀释至 10 0 m l;B组选用芬太尼 1mg代替 A组配方中的曲马多。手术结束后开始镇痛 ,背景剂量 2 ml/h,PCIA量 0 .5 ml,锁定时间 15 min。术后进行视觉模拟评分 (VAS)及布氏舒适评分 (BCS) ,并观察头痛、恶心、呕吐、皮肤瘙痒、呼吸抑制等副作用。结果 :1综合镇痛质量 A组与 B组无明显差异 (P>0 .0 5 ) ;2恶心呕吐的发生率 A组高于 B组 (P<0 .0 1)。结论 :曲马多、芬太尼 PCIA用于非体外循环冠状动脉搭桥术后病人静脉自控镇痛均可取得满意的效果 ,但芬太尼较曲马多的不良反应少 ,更适合术后镇痛。

Objective To investigate the analgesic and adverse effects of tramadol and fentanyl used for patient-controlled intravenous analgesia(PCIA)after off-pump coronary artery bypass grafting(CABG).Methods Thirty-six patients (32 male, 4f emale) aged 47-76 yr weight 52-95kg undergoing off-pump (CABG) were randomly divided into two groups.Patients received 800 mg Tramadol,10 mg midazolam and 4 mg andasum, in group A(n=18),1 mg fentanyl was used instead of tramadol of group A in group B(n=18). Postoperative analgesia was provided by PCIA pump with background infusion of 2 ml/h and a bolus of 0.5 ml with a 15 min lock-out interval.Results ①There was no significant difference in VAS scores between the two groups(P>0.05). ②Complications as nausea, vomiting and vertigo were higher significantly in group A than in group B(P<0.01).Conclusion Either tramadol or fentanyl is satisfied used for PCIA after OPCABG, but the side effects are much less with fentanyl than with tramadol.