硬膜外超前镇痛加静脉联合曲马多芬太尼自控镇痛的临床应用

目的：寻找一种临床上镇痛效果满意,易于管理,不良反应少且有利于术后恢复的镇痛方法。方法：225例手术拟行硬膜外（或腰硬联合）麻醉的、有术后镇痛需要的患者,分9组（两组对照组,7组实验组）所有病例均LCB管理模式。药物配方根据手术方式、性别、年龄、麻醉方式等加以调整。对照组VAS评分〉6分,病房作出处理退出观察;实验组VAS评分〉6分,由麻醉医生进行处理,静推混合液5ml作为强化;如果发现镇痛过深,即静注纳络酮0.1-0.2mg或取消镇痛。结果：①实验组1＋实验组与对照组1＋对照组2,X2检验,观察到硬膜外腔“超前镇痛”的意义。②实验组与实验组进行X2检验观察到在创伤早期使用强效镇痛药效果好,后期静脉持续镇痛可行。③对照组1＋对照组2与实验组5＋实验组6进行X2检验组观察到预防性使用强效镇吐药氟哌利多可以预防或减轻由镇痛药引起的恶心等副作用。结论：硬膜外腔超前给予镇痛药物是合理的,单次超前镇痛使用曲马多50-100ml不会导致尿潴留;硬膜外腔超前使用吗啡、静脉持续使用芬太尼、曲马多联合镇痛安全、可行,副作用轻微,易处理。

To search an analgetic way which is satisfactory, easily mange, less adverse effects, and is benificial to the recovery of patients. Method： 255 patients who had epidural anesthesia and need analgesia after operation were divided into 9 groups （ 2 control groups and 7 experimental groups ）. All cases wered used LCB mangemet mode. Pharmaceutical formulation was adjusted by modus operandi, gender, age and anaesthesia mode. Sickroom will not observe again if the VAS scores of the control groups were exceed 6. 5ml mix liquor was injected by vein if the VAS scores of experimental group were exceed 6. Naloxone will be injected by vein or cancel analgesia. Results： ①They were observed the significance of preemptive analgesia by χ^2 test. ②The experimental group and the experitntal group were tested by χ^2 test that the analgesia had good effect before wound earlier period, analgesia will go on at anaphase. ③were observed that using prophylactic the droperidol will prevent or relieve the adverse reactions such as nausea caused by pain - killer. Conclusion： Advanced administer pain - killer at epidural is reasonable, sigle preemptive analgesia used 50 - 100ml tramadol at epidural will not caused urimaru retention, Advanced used morphine and injected persistent fentanyl and tramadol is a safy, less adverse effect, easily analgetic way.