曲马多用于剖宫产术后静脉自控镇痛的临床效果评价

Evaluation of Tramadol for Patient-controlled Intravenous Analgesia after Cesarean Section

[目的]比较曲马多与吗啡对剖宫产术患者的镇痛效果及不良反应。[方法]对60例ASAⅠ-Ⅱ级的剖宫产术患者进行随机、双盲研究。分为3组：曲马多组（T组,n=20）,吗啡组（M组,n=20）,曲马多＋恩丹西酮组（TO组,n=20）,分别于术后4、8、12、16、20、24 h观察BP、HR、疼痛评分VAS（视觉模拟评分法）、Prince Henry评分（PHS）及恶心、呕吐、瘙痒、尿潴留等不良反应,并记录24 h的用药量。[结果]VAS、PHS评分3组患者无显著性差异;恶心呕吐发生率比较：T组与M组〉TO组,T组与M组间无显著性差异;瘙痒及尿潴留的发生率M组高于其他两组。[结论]曲马多用于剖宫产术的患者能够获得与吗啡相同的镇痛效果且瘙痒及尿潴留的发生率低。虽恶心呕吐的发生率较高,但联合应用恩丹西酮后可明显降低。

[Objective] To evaluate the effects and side effects of tramadol and morphine used for patient-controlled intravenous analgesia（PCIA）.[Methods]A single-center,randomized double-blind study of ASAⅠ-Ⅱ 60 patients undergoing cesarean section was performed.The patients were divided into there groups： tramadol group（group T,n=20）,morphine group（group M,n=20）and tramadol＋ondansetron（group TO,n=20）.The study lasted for 24 hours.Heart rate,blood pressure,respiration rate,VAS,Prince Henry score（PHS） and rate of side effects such as nausea and vomiting were observed.The consumption of analgetics in 24 hours was recorded.[Results] The score of VAS and PHS showed no difference between there groups.The rate of postoperative nausea and vomiting（PONV） of group T and group M was higher than that of group TO,and there was no difference between group T and group M.The rate of postoperative pruritus and urine retention of group M was higher than that of the two other groups.[Conclusion] Tramadol PCIA can provide the same analgesia effect as morphine in patients undergoing cesarean section and the rate of pruritus and urine retention was lower than that of morphine.Though the side effects such as nausea and vomiting were apparent,tramadol in combination with ondansetron can significantly reduce the incidence of side effects.