婴幼儿术后用曲马多持续静脉镇痛的临床观察

Treatment of post-surgical infantile pain with tramal by continuous intravenous analgesia

目的：观察曲马多持续静脉注射对婴幼儿术后镇痛效果。方法：120例泌尿外科婴幼儿，分为A、B、C3组，各40例，手术后A组恩丹西酮0．1mg·kg^-1静脉滴注，B组曲马多6mg·kg^-1·d^-1＋恩丹西酮0．1mg·kg^-1静脉滴注，C组曲马多12mg·kg^-1·d^-1＋恩丹西酮O．1mg·kg^-1静脉滴注，药物稀释至100mL，4mL·h^-1给药。镇痛2，6，12，24h和更换敷料时做镇痛、镇静评分，统讦镇痛满意率及不良反应发生率。结果：镇痛初期（2h）各组镇痛效果差异无显著性，其他时点，A组镇痛效果不佳，满意率最低；C组恶心、呕吐发生率较高，镇痛满意率与B组相当；B组镇痛效果佳且满意率高。结论：婴幼儿术后用曲马多6～12mg·kg^-1·d^-1镇痛，起效快，不增加恶心、呕吐发生率，无过度镇静、呼吸抑制。

OBJECTIVE To observe the effectiveness and adverse reaction of tramal in treatment of Post-surgical infantile pain by continuous intravenous analgesia. METHODS 120 case infantile patiens, ASA physical status Ⅰ to Ⅲ, undergoing urinary surgery of Hypoyastrium or Perineum. All infants were randomly divided into 3 equal groups： A： （n = 40, recived continuous intravenous analgesia with N. S ） ;B： （n = 40, recived continuous intravenous analgesia with tramal 6 mg·kg^-1·d^-1 ）; C： （n = 40, recived continuous intravenous analgesia with tramal 12 mg·kg^-1·d^-1） . CHEOPS（the children hospital of eastern ontario pain scale）, UMSS（the university of michigan sedation scale）, rate of satisfaction . rate of somnolence after recovery consciousness, Ondansetron were used and PONV（post operative nausea and vomit）were recorded, effects of drug on the respiratory and circulatory systems were assessed at fixed time after operation. RESULTS Compareing A with B, C group the CHEOPS were increased significantly during 2 - 24 h , P〈0. 01 ; Compareing C with B group, the CHEOPS were decreased very significantly during 2 - 24 h, P〈0. 05. The respiratory and circulatory systems were steady all the time. CONCLUSION Receiving continuous intravenous analgesia with tramal 6- 12 mg ·kg^-1·d^-1 is a safe and efficient way in post-surgical analgesia of infantile patiens.