不同镇痛药物在子宫全切除术后硬膜外镇痛对比

A Comparison of Various Analgesia Drugs for Epidural Analgesia after Total Hysterectomy

目的：寻求子宫全切除术后，于硬膜外镇痛中最佳的副作用小的镇痛药物。方法；选择硬膜外（均为L2～3间隙）麻醉效果良好的60例子宫全切除患者，随机分成：芬太尼组（n=20）、曲马多组（n=20）和吗啡组（n=20），均采用上海怡新YX-Ⅰb型100mL，注速2mL／h镇痛泵。分别于术后2h、5h、12h、15h和第二天9时、14时、17时、24时及第三天10时（拔除时）。观察并记录病人BP、HR、RR、SpO2及镇痛（VAS法）效果、追加药物、下肢运动情况和恶心呕吐、头痛头晕、皮肤骚痒（均因留置导尿管未观察尿潴留）等副作用情况。结果：三组病人BP、HR、RR及下肢术后2h、5h运动无差别；吗啡组、芬太尼组SpO2有不同程度下降。对比无差别；在镇痛方面，三组无统计学意义（P〉0．05）；副作用发生方面，吗啡组〉芬太尼组〉曲马多组（P〈0．05），具有统计学意义。结论：曲马多为子宫全切除术后硬膜外镇痛副作用少、镇痛效果好的镇痛药物。

Objective： To find a kind of analgetica which has the best effect and less adverse reaction for epidural analgesia after total hysterectomy. Methods： 60 patients who received good epidural anesthesia （L2-3intervertebral space） so as to operate total hysterectomy were randomly assigned in group fentanyl （n=20）, group tramadol （n=20） and group morphine （n=20）. The anesthesia was performed using type YX-1b 100ml 2ml/h analgesia pump made in Shanghai Yixin Company. Level of BP, HR, RR, SpO2 was Observed and recorded as well the effect of the analgesia respeetively; while the adverse effects including to boost, lower limbs exercise, nausea ＆ vomiting, eephalagia ＆ dizziness, skin itching （didn＇t observe the urinary retention because of UCI） were observed after 2, 5, 12, 15 hours surgery, on the second day, same observation was done at 9, 14, 17, 24 o＇clock and at 10 o＇clock on the third day. Results： There was no difference on BP, HR, RR and lower limbs exercise after 2, 5 hours surgery in three groups. In group morphine and group fentanyl, the level of SpO2 declined. There was no statistical significance （P〉0. 05） among the three groups. The adverse reaction among three groups was as following., the morphine group 2〉 fentanyl group 2〉 tramadol group （P〉0. 05）. Conclusions.. Tramadol is the better analgetiea which had little adverse reaction and better analgesia effect for epidural analgesia after total hysterectomy.