雷米芬太尼复合曲马多用于术后病人自控静脉镇痛

Patient controlled intravenous analgesia with remifentanil combined with tramadol

目的比较不同浓度雷米芬太尼与曲马多联合用于上腹部手术后病人自控静脉镇痛(PCIA)的临床效果。方法45例30～70岁拟行上腹部手术病人随机分为三组:单独曲马多组(A组),低浓度雷米芬太尼(0.0125μg.kg-1.min-1)与曲马多联合用药组(B组)、高浓度雷米芬太尼(0.025μg.kg-1.min-1)与曲马多联合用药组(C组),每组15例。术毕拔管后使用PCIA,并分别记录术后15min(T0)、2h(T1)、5h(T2)、10h(T3)和24h(T4)共5个时点的疼痛程度(PI)、疼痛缓解程度(PAR)、生命体征的变化及各种不良反应。结果T0时PI值三组间差异无统计学意义;B组T1、T2和T4时及C组T1～T4时的PI值均明显低于A组(P<0.05),C组T1～T4时的PI值明显低于B组(P<0.05);C组T1～T4时的PAR值明显低于A组和B组(P<0.05)。三组的呼吸抑制、头晕、恶心呕吐的发生率差异均无统计学意义。结论0.025μg.kg-1.min-1雷米芬太尼与曲马多联合用药术后镇痛效果满意,起效时间短,不良反应发生率与0.0125μg.kg-1.min-1雷米芬太尼与曲马多联合用药组及单独曲马多组差异无统计学意义。

Objective To compare the analgetic effect and side effects of remifentanil combined with tramadol in patient controlled intravenous analgesia（PCIA）. Methods Forty-five patients undergoing upper abdominal operation under general anesthesia were divided randomly into 3 groups with 15 cases each. In group A, tramadol was infused continuously at a rate of 0.3 mg · kg^-1 . h^-1 ,in group B, remifentanil at a rate of 0. 0125μg·kg^-1 · min^-1 , and in group C, remifentanil was infused continuously at a rate of 0. 025μg · kg^-1·min^-1. PI,PAR, vital signs, total dosage, PCIA times and side effects were collected at 15 min（T0 ） ,2 h（T1）, 5 h（T2 ）, 10 h（T2） and 24 h（T4 ） after operation. Results At To ,there was no significant difference in PI among three groups. PI of group B at T1 ,T2 and T4 ,and of group C at T1 to T4 was significantly lower than that of group A（P〈0.05）. PI of group C at T1 to T4 was significantly lower than that of group B（P〈0.05）. PAR of group C at T1 to T4 was significantly lower than that of group A and B （P〈0.05）. No significant differences were found in the incidence of nausea, dizziness or respiratory inhibition, and no chest rigidity or pruritus was found among three groups. Conclusion Remifentanil 0. 025 μg · kg^-1 · min^-1 combined with tramadol used for PCIA is effective and safe.