等效剂量曲马朵、丁丙诺啡与吗啡用于术后病人自控镇痛的比较

Comparison of clinical effects among tramadol,buprenorphine and morphine in patient-controlled analgesia

目的比较曲马朵、丁丙诺啡与吗啡用于术后病人自控静脉镇痛（PCIA）的效果及副作用。方法53例ASAⅠ～Ⅱ级上腹部择期手术患者随机分为曲马朵组（T组，n=18）、丁丙诺啡组（B组，n=17）和吗啡组（M组，n=18），镇痛用药分别为10mg／ml曲马朵、0．03mg／ml丁丙诺啡及1mg／ml吗啡，辅助用药均为0．1mg／ml氟哌利多。采用Baxter APⅡ型电脑泵，按负荷量2．5ml＋持续量0．5ml／h＋单次量1ml（LCP）模式给药。术后4、8、16、24h分别记录病人镇痛评分（VAS）、舒适评分（BCS）、镇静评分（Ramsay评分）、24h镇痛药物用量、按压次数／实际给药次数比值（D／D比值）以及恶心、呕吐、皮肤瘙痒、呼吸抑制等不良反应发生情况。结果3组病人各时间点VAS及BCS评分无显著性差异（P〉0．05），但T组D／D比值及术后24h镇痛药物用量明显大于其他两组（P〈0．05）。B组2例、M组1例患者出现嗜睡，但3组Ramsay评分无显著性差异（P〉0．05）；T组8例、B组5例、M组4例出现恶心；T组1例、B组2例，M组3例出现皮肤瘙痒。结论曲马朵与丁丙诺啡可安全地用于上腹部手术后病人自控静脉镇痛，但其临床效应并未超过吗啡。

Objective To compare the analgesic and side effects of tramadol, buprenorphine and morphine in equipotent dosage in patient-controlled intravenous analgesia （PCIA）. Methods 53 patients （ASA Ⅰ-Ⅱ） scheduled for upper abdominal surgery were randomly allocated to receive 10mg/ml tramadol （group T） or 0.03mg/ml buprenorphine （group B） or 1mg/ml morphine （group M） plus 0.1mg/ml droperidol. Baxter APⅡ PCA pump was used to administer the different analgesic according to the model of LCP, with the amount of loading dose, continuous infusion and bolus of 2.5ml, 0.5ml/h, 1ml respectively. At 4, 8, 16 and 24h postoperatively, pain scores in VAS, comfort scale in BCS, sedation scores with Ramsay score, and the incidences of nausea, vomiting, pruritus, respiratory depression were assessed. Drug consumption in the first 24h and the D/D ratio （demand/deliver） were also recorded. Results VAS and BCS scores showed no significant difference among the 3 groups, but drug consumption within the first 24h and the D/D ratio in group T were higher than those in other 2 groups （P〈0.05）. Although 2 patients in group B and 1 in group M felt sleepy, the Ramsay scores were similar among the 3 groups （P〉0.05）. 8 patients in group T, 5 in group B and 4 in group M suffered from nausea; 1 patient in group T, 2 in group B and 3 in group M complained of pruritus. No respiratory depression was observed in all cases. Conclusion Tramadol and buprenorphine can be safely used as PCIA in patients undergoing upper abdominal surgery, but they are not superior to morphine.