奈福泮和阿片类药物在硬膜外自控镇痛中的应用

Comparative Study on Tramadol and Opioids in Patient-controlled Epidural Analgesia

目的:比较奈福泮与阿片类药物用于子宫切除术后患者的镇痛效果。方法:90例ASAⅠ￣Ⅱ级择期手术的患者,随机分为奈福泮组(Ⅰ组)、芬太尼组(Ⅱ组)和吗啡组(Ⅲ组),每组30例,含药量分别为奈福泮0.4g/L、芬太尼2mg/L、吗啡0.1g/L,均加0.1%罗比卡因,总量100mL,并设置为2mL/h,自控按压次数(PCA)为0.5mL/次,锁定时间为15min,镇痛时间24￣48h。观察患者镇痛效果(VAS评分)、镇静评分(SS评分)及不良反应。结果:镇痛评分Ⅰ组与Ⅱ、Ⅲ组差别无统计学意义(P>0.05),组内Ⅰ组术后4h明显高于16,24,48h(P<0.05);SS评分Ⅰ组与Ⅱ、Ⅲ组差别有统计学意义(P<0.01)。不良反应发生率Ⅱ、Ⅲ组明显高于Ⅰ组(P<0.01)。结论:奈福泮镇痛效果满意,不良反应比吗啡和芬太尼更低,且作用强度随时间的延长而明显增强。

Objective： To compare the effects of tramadol and opioids in postoperative patient-controlled epidural analgesia （PCEA）. Methods： Ninety patients with ASAⅠ - Ⅱwere randomly divided into three groups including tramadol group （group Ⅰ, n = 30, 0.4ffL）, fentanyl group （group Ⅱ, n=30, 2 mg/L） and morphine group （group Ⅲ, n=30, 0.1 g/L）. nought point one percent ropivacaine were added in three groups, and the indexes were gross 100 mL, setup 2 mL/h, PCA 0.5 mL each time, lock time fifteen minutes, and analgesia time 24-48 hours. The analgesia effects （VAS score）, sedation score （SS） and side effect were observed. Results： There were no significant differences of VAS among three groups （P〉 0.05） and VAS of 4 hours was significantly higher than those of 16, 24 and 48 hours after operation （P 〈0.05）. There were significant differences of SS among three groups （P 〈 0.01）. The rates of side effect of group Ⅱ and Ⅲ were significantly higher than that of group I （P 〈 0.01）. Conclusion： Tramadol has good analgesia effect and less side effects than fentanyl and morphine, and its analgesia effect is more and more greater go with time passing.