罗哌卡因复合曲马多与芬太尼应用于子宫全切术后硬膜外镇痛的临床研究

A comparison of epidural ropivacaine infusion combined with fentanyl or tramadol for postoperative analgesia after abdominal hysterectomy

目的:比较曲马多、芬太尼分别和罗哌卡因合用对于子宫全切术后硬膜外镇痛的作用,以期为临床安全合理用药提供依据.方法:选择ASA Ⅰ～Ⅱ级经腹子宫全切患者60例,随机分为三组.R组:0.15%罗哌卡因(n=20);F组:0.15%罗哌卡因+0.000 4%芬太尼(n=20);T组:0.15%罗哌卡因+0.5%曲马多(n=20).三组术后均应用首剂镇痛药0.5%罗哌卡因6 ml硬膜外注入,连接一次性微量泵进行硬膜外镇痛.监测术后不同时间的VAS疼痛评分、心率、平均动脉压;观察恶心等不良反应和下肢运动阻滞情况以及肛门排气时间;总体满意度评分.结果:R组VAS评分明显高于F组以及T组,有显著性差异(P＜0.05);F组和T组VAS评分无明显差异(P＞0.05);F组恶心、呕吐发生率高于R组和T组(P＜0.05);心率、平均动脉压各组间以及术前无显著性差异(P＞0.05);F组和T组镇痛总体满意度优良率明显高于R组(P＜0.05).结论:曲马多、芬太尼分别与罗哌卡因合用均可达到有效的术后硬膜外镇痛效果,曲马多与罗哌卡因配伍副作用发生率较低,是一种更为为安全有效的硬膜外术后镇痛配方.

Objective： Comparison with the effect of equivalent dose of fentanyl and tramadolin combination with ropivacaine on continuous epidural postoperative analgesia after abdominal hysterectomy is of significance for safety and reasonable administration in epidural postoperative analgesia. Methods： Sixty patients （ ASA class Ⅰ -Ⅱ ） , undergoing abdominal hysterectomy, were randomly divided into three groups （20 in each group） to receive 0. 15% ropivacaine alone （Group R） , 0. 15% ropivacaine plus 0. 0004% fentanyl （Group F） , and 0. 15% ropivacaine plus 0. 5% tramadol （ Group T）. Postoperatively all the three groups were given an initial epidural loading dose of 0. 5% ropivacaine 6 ml, then the disposable micro- infusion pump was applied to continuous epidural postoperative analgesia. VAS, HR, MAP were recorded at different time. The incidence of side - effect, motor block, the time for passage of gas by annus and global satisfaction score were assessed. Results： The VAS in Group F or Group T were significantly less than that in Group R （ P 〈 0. 05 ） and no significant difference was noted between Group F and Group T （ P 〉 O. 05 ）. The incidence of nausea and vomiting in Group T was significantly lower than that in Group F （ P 〈0. 05）. HR, MAP had no significantly difference at different time in the three groups. Compared with Group R significantly higher the global satisfaction score in Group F or Group T （P 〈0. 05 ）. Conclusion： Ropivacaine infusion in combination with fentanyl or tramadol is efficient for epidural postoperative analgesia. Ropivacainc infusion in combination with tramadol is the best choice because of the less side - effect.