曲吗多与丁丙诺啡不同配伍术后病人自控硬膜外镇痛效应的比较

The effects of postoperative patient-controlled epidural analgesia with different combinations of tramadol and/or buprenorphine:a comparative study

目的:比较曲吗多、丁丙诺啡不同配伍术后病人自控硬膜外镇痛(PCEA)的临床效应。方法:150例(ASAⅠ～Ⅱ)手术病人随机分成6组,T_1组(n=25)镇痛药液为0.6%曲吗多;T_2组(n=25)0.6%曲吗多+0.15%丁哌卡因;B_1组(n=25)0.0015%丁丙诺啡+0.15%丁哌卡因;B_2组(n=25)用B_1组药液+0.6%曲吗多;C_1组(n=25)0.15%丁哌卡因;C_2组(n=25)0.0015%丁丙诺啡。采用Graseby-9300泵,选择负荷剂量+持续剂量+PCA(简称ICP)给药模式,其剂量分别为5ml-0.5ml-1ml。结果:(1)6组病人首次24小时PCEA用药量相似(P>0.05);(2)镇痛效应:VAS评分及总按压数/实进数比值为B_2组<B_1组<T_2组<T_1组≈C_2组<C_1组(P<0.05～0.01);(3)并发症:恶心,呕吐的发生率分别为4%～24%,以B_2组较高(20%～24%):4%～8%病例有嗜睡和瘙痒。结论:术后行PCEA时,联合用药的镇痛效应优于单一药物,仅用低浓度局麻药而不用镇痛药物的效果最差;以2种或3种不同类型的药物联合使用且选用小剂量为宜,否则并发症有增加的趋势。

Objective: To compare the clinical effects of postoperative patient controlled epidural analgesia (PCEA) with different combinations of tramadol and/or buprenorphine. Method:The 150 cases of surgical patients were ran domly divided into 6 groups: 0.6% tramadol (group T_1). mixture of 0.6% tramadol and 0.15% bupivacaine (group T_2), mixture of 0.0015% buprenorphine and bupivacaine (group B_1) , mixture of 0. 0015% buprenorphine, bupivacaine and 0.6% tramadol(group B_2). 0.15% bupivacaine(group C_1), 0.0015% buprenorphine(group C_2). With a Graseby- 9300 PCA pump in the loading-continuous-PCA model, the doses were 5mL-0.5ml-1ml respectively. Result: (1)In the first postoperative 24 hours the amount of drugs used in each group was similar; (2)1n these six groups, both visual analog scale scores and the ratios of tatol deliveries to demands were B_2<B_1<T_2<T_1≈C_2<C_1group(P<0.05-0. 01); (3)The incidence of nousea and vomitting were 4% to 24% separately, and of group B_2 was a little higher(20%~ 24%) than that of other groups. 4% to 8% of all the patients had somnolence and pruritus. Conclusion:The effects of combined analgesics during postoperative PCEA are more than that of only one analgesic. Small does were recommend ed when 2 or 3 different kinds of analgesics used in combination.