曲马多应用于不同骨伤手术后患者自控静脉镇痛的临床观察

Clinical Observation of Tramadol for Patient Controlled Intravenous Analgesia after Different Prthopedic Surgeries

目的:观察曲马多对不同类型的骨伤手术后患者自控静脉镇痛的临床效果。方法:将按美国麻醉师协会(ASA)分级标准评为Ⅰ～Ⅱ级的择期骨伤手术患者192例根据手术部位分为6组:上肢长骨干组(Ⅰ组)、肩肘关节组(Ⅱ组)、下肢长骨干组(Ⅲ组)、足踝组(Ⅳ组)、髋膝关节组(Ⅴ组)、脊柱骨盆组(Ⅵ组)。手术结束前10min将镇痛泵与患者连接并开启进行自控静脉镇痛,镇痛用药为曲马多15mg·kg-1(联合格拉司琼9mg止吐)。分别于术毕清醒时及术后2、4、12、24及48h记录生命体征指标,进行疼痛评分(视觉模拟评分法,VAS)及镇静评分(Ramsay评分法)并观察不良反应发生率及调查患者对术后镇痛的满意度。结果:各组各时间点相关生命体征指标差异无统计学意义(P>0.05);术后各组各时间点Ramsay评分差异无统计学意义(P>0.05);术后2、4h各组VAS评分在3～6分左右,均高于其他时间点,差异有统计学意义(P<0.05),并且Ⅱ、Ⅳ组术后2、4、12、24h的VAS评分在3～6分左右,均高于同时间点其他各组的1～3分,差异有统计学意义(P<0.05);不良反应发生率各组差异无统计学意义(P>0.05),且均未发现严重不良反应;Ⅱ、Ⅳ组患者满意率显著低于其他组,差异有统计学意义(P<0.05)。结论:曲马多15mg·kg-1进行患者自控静脉镇痛对于大多数骨伤手术能达到较好的镇痛效果,无明显的不良反应,但对于肩肘关节及足踝部位的手术镇痛效果相对欠佳。

OBJECTIVE： To observe the clinical efficacy of tramadol for patient controlled intravenous analgesia after different orthopedic surgeries. METHODS： 192 ASA physical status Ⅰ ～ Ⅱ patients, scheduled for elective orthopedic surgery, were divided into 6 groups according to operative site： upper extremity long bone surgery group （group Ⅰ ）, shoulder and elbow surgery group （group Ⅱ ）, lower limb long bone surgery group （group Ⅲ ）, ankle surgery group （group Ⅳ ）, hip and knee surgery group （group Ⅴ ）, spinal and pelvic group （groupⅥ）. 10 min before the end of surgery, anesthesia pump was opened and connected to patients for patient controlled intravenous analgesia, and the formula of analgesic solution was as follows： tramadol 15 mg·kg^-1 combined with granisetron 9 nag were used to antiemetics. The vital signs were recorded when being conscious and 2,4,12,24 and 48 h after operation, and pain score （visual analogue scale, VAS） and sedation score （Ramsay score） were conducted. The incidence of adverse drug reaction and degree of satisfaction were observed. RESULTS： There was no statistical significance in related vital signs in different groups at different time points （P〉0.05） ; there was no statistical significance in Ramsay score in different groups at different time points （P〉0.05）; VAS scores of each group 2 and 4 h after operation were between 346 points and signif- icantly higher than other time points, there was statistical significance （P〈0.05） ; the VAS scores of group Ⅱ and Ⅳ 2,4, 12 and 24 h after operation were between 3～6 points and higher than 1～3 of other groups at the same time interval. There was statistical significance （P〈0.05）. There was no statistical significance in the incidence of ADR （P〉0.05）. No serious ADR was found in each group. The degrees of satisfaction in group Ⅱ and Ⅳ were significantly lower than in other groups, there was statistical signifi-cance （P〈0.05）. CONCLUSION： Tramadol 15 mg·kg^-1 is effective for patient controlled intravenous analgesia after most orthopedic surgeries without obvious ADR, but it is a bit week for analgesia of shoulder and elbow surgery and ankle surgery.