曲马多与芬太尼静脉PCA用于心脏外科术后镇痛疗效的研究

A Controlled Study of Tramadol and Fentanyl for Releasing Postoperative Pain after Cardiac Surgery with Intravenous PCA

目的观察曲马多与芬太尼静脉PCA用于心脏外科术后镇痛的疗效、安全性及副作用。方法30例心脏手术病人随机分为曲马多组(Ⅰ组)和芬太尼组(Ⅱ组),每组各15例。镇痛药物Ⅰ组为芬太尼20 mg/L,Ⅱ组为曲马多20 g/L。参数设置:负荷剂量2 ml,持续输注剂量1 ml,单次给药剂量1 ml,锁定时间5 min,每4小时最大限量30 ml。负荷量注射完毕后记录镇痛起效时间;镇痛开始后12、24、36和48 h记录疼痛VAS评分、PCA需求按压次数和有效按压次数、药物用量、镇静程度评分;术后各种并发症及不良反应发生率;记录镇痛满意度NRS评分。结果Ⅱ组病人镇痛起效时间显著快于Ⅰ组(P<0.01),两组疼痛评分、按压次数、药物用量、镇静评分、镇痛满意度差别无统计学意义(P>0.05),术后并发症与不良反应发生率有不同(P<0.05)。结论曲马多与芬太尼静脉PCA均可安全、有效地应用于心脏手术后病人,需注意其副作用。

Objective To compare the effect, safety and side effects of Tramadol and Fentanyl for releasing postoperative pain after cardiac surgery with intravenous PCA. Methods 24 patients were randomly allocated to subcutaneous PCA group （group Ⅰ , n=15） and intravenous PCA group （group Ⅱ ,n=15）. The 20 mg/L Fentanyl was used in group Ⅰ and the 20 g/L Tramadol was administered in group Ⅱ. PCA setting. Loading dose of 2 ml ,continuous dose of 1 ml/h, bolus dose of 1 ml/h , lockout time 5 mins, and 4 hours limit of 30 ml were set. Onset of analgesia was recorded after injection of loading dose. The following indexes were recorded at 12, 24, 36 and 48 hours after the PCA pumps were used. VAS scores of pain, demanded delivery effective delivery, drug dose, sedation score, side effects, and patient satisfaction. Results Onset of analgesia of Group Ⅰ was significantly faster than that of Group Ⅱ （P＜0.01）. There were no significant difference in VAS scores of pain, demanded delivery effective delivery, drug dose, sedation score, and patient satisfaction（P＞0.05）. There was significant difference in side effects（P＜0.05）. Conclusion Tramadol and Fentanyl can relief pain in patients after cardiac surgery safely and efficiently, but side effects should be taken to consideration.