舒芬太尼与曲马多用于术后病人静脉自控镇痛的比较

Clinical study of patient-controlled analgesia with intravenous sufentanil and tramadol after operation

目的观察比较全麻术后舒芬太尼与曲马多病人自控静脉镇痛(PCIA)的临床镇痛效果与不良反应。方法选择全身麻醉手术病人90例。美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级,年龄18～50岁,随机分两组:A组(舒芬太尼组)45例,选择舒芬太尼0.1mg+利多卡因100mg+地塞米松5mg+生理盐水稀释至100mlPCIA泵入;B组(曲马多组)45例,选择曲马多800mg+利多卡因100mg+地塞松5mg+生理盐水稀释至100mlPCIA泵入。两组背景剂量2ml/h,单次追加剂量0.5ml,锁定时间15min。观察患者24h内用药量、按键次数、心率、呼吸频率、脉氧饱和度、视觉模拟评分法(VAS)、镇静评分、恶心呕吐。结果A组患者的VAS评分、镇痛药消耗量及按压次数显明显低于B组(P<0.05)。镇静评分,A组镇静评分达2分者高于B组,两组差异有显著性(P<0.05)。术后恶心呕吐发生率,B组明显高于A组。心率和呼吸频率,B组普遍略高于A组,术后血氧饱和度两组差异无显著性。结论舒芬太尼是目前用于人体最强效的芬太尼类镇痛药,镇痛作用确切,安全可靠、恶心呕吐等不良反应发生率低;曲马多在单一途径中镇痛作用较弱。

Objective To compare the pain relief efficacy and complication of sufentanil and tramadol intravenous patient - controlled analgesia PCA（ PCIA）. Methods Ninety American Society of Anaesthetist Ⅰ～Ⅱ patients between 18 and 50 years of age scheduled for radical mastectomy were divided randomly into two groups：Group A （ sufentanil,n =45） PCIA - sufentanil 0.1 mg＋ lidocaine 100 mg＋ decaspray 5mg＋ NS to 100 ml;Group B （tramadol, n =45） PCIA-tramadol 800 mg＋ fidoeainel00mg＋ decaspray 5 mg＋ NS to 100 ml. PCA settings was：bolus dose of 0.5 ml, background infusion of 2 ml/h, lockout time of 15 min. The following parameters, were recorded： dosage of drugs, press key, heart rate, respiratory rate, SO2% , VAS,Sedation Score （SS） ,the rates of postoperative nausea and vomit （PONV）. Results VAS, dosage of drugs, and times of key press in group A were remarkably lower than those of group B （ P 〈0.05）. SS of group A achieved 2 or more was higher that of group B （ P 〈0.05 ）. PONV of group B was significantly higher than that of group A, heart rate and respiratory, rate were, slightly higher in group A than those in group B, but There was no significant difference between two groups in SO2%. Conclusion PCIA with sufentanil is more effective than tramadol, which might be lower in the rate of complications.