开胸术后曲马多与芬太尼联合静脉镇痛及其对呼吸功能的影响

Effects of Pain and Their Effect on Pulmonary Function of Tramadol with Fentanyl on Patient-controlled Analgesia for Postthoracotomy

目的:观察曲马多复合芬太尼静脉镇痛在开胸术后镇痛及对肺功能的影响。方法:60例择期行肺叶切除术病人(ASAI^II)随机分为2组,观察组(n=30):1%曲马多+1.5μg/m l芬太尼,对照组(n=30):0.125%布比卡因+芬太尼2μg/kg;采用10cm视觉模拟评分尺评估术后1d、2d静息和咳嗽疼痛评分,测量术前和术后1d、2d肺功能(用力肺活量FVC、1s用力呼出量FEV1、呼气峰流速PEF)和血气,记录副作用、肺部并发症和术后住院日。结果:①镇痛效果术后1d、2d硬外组静息和咳嗽VAS评分低于静脉组,但无统计学意义(P>0.05);②呼吸功能在术后1d、2d 2组肺功能FVC、FEV1、PEF)、动脉血气、呼吸频率无显著差异(P>0.05);③副作用无显著差异;④均无肺部合并症发生,术住院日无显著差异。结论:曲马多复合芬太尼静脉镇痛应用于开胸手术镇痛效果可行,操作简单,为该类手术镇痛提供了又一种选择。

Objective： To observe the effects of pain and their effect on pulmonary function of tramadol with fentanyl on patient -controlled analgesia for postthoracotomy. Method： Sixty patients, ASA grade Ⅰ～Ⅱ, undergoing elective pneumonecotomy were randomly divided into two groups： group Ⅰ （n = 30 ）, received patient - controlled analgesia （ PCA ） with intravenous of tramadol with fentanyl; and group Ⅱ （ n = 30 ） received continuous thoracic epidural bupivacaine with fentanyl. Analgesia was tested using a visual analog pain scale（ VAS） （0 ～ 10cm）. Pulmonary function were measured on 1st and 2nd day postoperatively, The incidence of side -effects, pulmonary complications and the length of hospital stay were also recorded. Resuits： The pain scores were lower in group Ⅱ, but compared to group Ⅰ, there was no significant difference （ P 〉 0. 05 ） ; Pulmonary function and the length of hospital stay was similar in both groups. Conclusion：Tramadol with fentanyl on patient- controlled analgesia is a safe and effective method for postthoracotomy.