曲马多和咪达唑仑联合静脉应用镇痛促进胃肠肿瘤患者术后快速康复的临床研究

Application of Tramadol combined with midazolam for intravenous analgesia on postoperative rapid recovery in patients with gastrointestinal cancer

目的:观察研究胃肠外科肿瘤患者术后快速康复的方法的安全性及实用性。方法:收集2008年8月至2010年8月间我科210例平诊胃肠道恶性肿瘤患者,随机分为两组。A组(治疗组):应用曲马多300 mg+咪达唑仑30 mg+生理盐水60 mL,静脉微泵控制输入(2.5 mL/h),持续24 h输入,连续3 d止痛114例。B组(对照组):采用传统术后8 h后3 d内按照患者诉求给予曲马多每次100 mg肌注止痛,每天最多3次,共96例。比较两组的患者疼痛程度、术后舒适度、术后下床活动时间、术后坠积性肺炎例数及住院天数、睡眠质量评分的差异。结果:治疗组总分(124.35±14.10)分,对照组总分(191.75±16.67)分,两组总分相比(t检验)差异有统计学意义(P<0.05)。下床时间治疗组(3.41±0.93)d,对照组(5.53±1.15)d,两组相比(t检验)差异有统计学意义(P<0.05)。术后坠积性肺炎治疗组10例,对照组20例,两组相比(χ2检验)差异有统计学意义(χ2=6.192,P<0.05)。住院天数两组相比(t检验)差异有统计学意义(P<0.05)。睡眠质量评分治疗组(20.87±3.91)分,对照组(13.58±4.49)分,两组相比(t检验)差异有统计学意义(P<0.05)。结论:曲马多和咪达唑仑联合静脉应用对胃肠肿瘤患者术后的疼痛减轻程度、术后舒适度、术后下床活动时间、术后坠积性肺炎及住院天数、睡眠质量评分均明显优于传统术后镇痛方法,值得临床推广应用。

Objective：To carry out an observational research on safety and practicality of postoperative rehabilitation therapy regard- ing to gastrointestinal cancer patients. Methods ：210 patients collected from August 2008 to August 2010 with gastrointestinal cancer in our department were randomly divided into two groups. A group （treatment group） ： Tramadol 300 mg ＋ midazdam 30 mg ＋ saline 60 mL, intravenous micro pump control input （2.5 mL/h） , continuous 24-hour input. After 3 days in consecutive, pain was relieved in 114 cases. B group （control group） ： Traditionally, in 3 consecutive days beginning from 8 hours after surgery, intramuscular injection of tramadol 100 mg was carried out according to the demands of patients in these 96 cases, 3 times at the most within one day. Pain, postoperative comfort, postoperative activity time, the number of hypostatic pneumonia occurred hospital stays, and sleep quality were quantified and compared. Result ： Treatment group Total： （ 124.35 ± 14.10） points, the control group total： （ 191.75 ± 16.67 ） points, Two sets of scores （ t test） were significantly different （ P 〈 0.05 ）. As for activity time, treatment group ： （3.41 ± 0.93 ） days, control group：（5.53 ± 1.15）days, The resuhs（t test） varied greatly （P〈0.05）. Hypostatic pneumonia occurred： 10 in treatment group, 20 in control group, thus the results （χ2 test） were very different（χ5 = 6. 192, P 〈 0.05）. Time of hospitalization was significantly different （ P 〈 0.05 ）. Sleep quality score in treatment group ： （20.87 ± 3.91 ） points, control group ： （ 13.58 ± 4.49） points, the re- sults （ t test） varied widely （ P 〈 0.05 ）. Conclusion： Tramadol combined with midazolam for intravenous analgesia is much better than traditional method in terms of the effectiveness of pain-relief, postoperative activity time, less occurrence of hypostatic pneumonia, and shorter hospitalization time. Thus, it should be promoted in clinical application.