曲马多微泵持续给药术后镇痛的临床观察

Observation of Continuous Medication of Tramal with Micro-pump for Analgesia Postoperatively

目的观察曲马多经微泵连续静脉或硬膜外腔给药术后镇痛的临床效果并加以比较。方法：随机将术后病人150例（ASAI-Ⅱ级）分成3组：静脉组（Ⅰ组〕，硬膜外组（Ⅱ组）、对照组（Ⅲ组）。选择负荷剂量＋持续剂量，微泵连续给药模式（AuBEx）药物配方：Ⅰ组与Ⅱ组均用曲马多400mg＋氟呱利多5mg，用0．9％生理盐水稀释至50ml；Ⅲ组选用0．9％生理盐水50ml。结果：前两组病人术后镇痛效果无显著差异；Ⅰ组尿潴留发生率明显低于Ⅱ组（P＜0．05）；Ⅱ组的肠蠕动恢复明显快于Ⅰ组（P＜0．01），两组病人恶心、呕吐、皮肤瘙痒、呼吸抑制发生率无显著差异；Ⅰ组病人有8％镇静达中度，而Ⅱ组没有明显镇静现象；Ⅲ组术后6h血清皮质醇明显高于镇痛组（Ⅰ、Ⅱ组）（P＜0．01）。结论：曲马多不论经静脉还是硬膜外给药都达到较好的镇痛效果，减少了术后的应激反应。

Objective: To observe the effect of continuous intravenous medication of Tramal with micro - pump for analgesiapostoperatively compared with epidrual group. Methods: 150 cases postoperative patients were divided into 3 groups random-ly: intravenous group Ⅰ, epidural group Ⅱ and control group Ⅲ. The load dose and maintained dose were taken with continu-ous medication. Tramal 400mg and droperidol 5mg diluted in 50ml saline in intravenous and epidural groups, and 50mlsaline in control group. Results: The analgesia effect had no difference in group Ⅰand Ⅱ. Urine retention in group Ⅰ waslower than in group Ⅱ. The peristalsis in group Ⅱ recovered more rapidly than group Ⅰ. Nausea, vomiting, skin itching andrespiratory inhibiting symptoms had no difference in group Ⅰand Ⅱ. 8% patients in group Ⅰ had median sedation andgroup Ⅱ hadn't. The corticosteroid level in group Ⅰ was higher than in group Ⅱ and Ⅲ. Conclusion: Tramal has betteranalgesia effect whether in intravenous or epidural medication and could reduce stress reaction of post operation.