帕瑞昔布与曲马多复合吗啡术后静脉自控镇痛的比较

Patient-controlled intravenous analgesia after parecoxib or tramadol combined with morphine:a correlation study

目的:比较帕瑞昔布复合吗啡与曲马多复合吗啡用于术后持续静脉自控镇痛(PCIA)的效果与不良反应。方法:将60例择期行腰椎间盘摘除及椎弓根内固定术患者随机分为帕瑞昔布组及曲马多组,每组30例。帕瑞昔布组:吗啡20 mg、帕瑞昔布80 mg、胃复安60 mg加生理盐水稀释至100 mL;曲马多组:吗啡20 mg、曲马多400 mg、胃复安60 mg加生理盐水稀释至100 mL。记录术后4、12、24、48 h患者活动与静息疼痛评分、48 h内有效PCA按压次数及BP、HR、RR、SpO_2化,观察患者恶心、呕吐及头晕等情况。结果:帕瑞昔布组患者静息疼痛评分、活动疼痛评分均低于曲马多组(P<0.05);帕瑞昔布组、曲马多组48 h有效PCA按压次数分别为(7.00±4.2)次和(2.13±1.6)次,两组比较,差异有统计学意义(P<0.05)。帕瑞昔布组和曲马多组患者恶心、呕吐、头晕的发生率分别为10.2%、5.6%、5.7%和23.7%16.2%、40.3%,两组比较,差异有统计学意义(P<0.05)。结论:帕瑞昔布复合吗啡持续静脉自控镇痛用于椎弓根内固定术患者的镇痛效果较好,恶心、呕吐及头晕等不良反应较少。

Objective：To compare the efficacy and side-effects of patient-controlled intravenous analgesia （PC1A） after pareeoxib or tramadol combined with morphine. Methods ：60 patients undergoing selective lumbar discectomy and pedicle screw fixation were randomly divided into two groups （n = 30 each）. In parecoxib group, patients were given 20 mg morphine ,80mg parecoxib,60 mg metoelopramide and 100mL saline. And in tramadol group ,20 mg morphine ,400mg tramadol 60rag metoclopramide and 100mL saline, respectively. The pain scoring of activity and rest, the effective times of PCA within 48h and the changes of BP, HR, RR and SpO2. Furthermore, the vomiting and dizziness were also observed. Results ： Both rest scoring and activity scoring in parecoxib group were lower than those in tramadol group （P 〈 0.05）. The the effective times of PCA within 48h was respectively （7.00 ± 4.2） and （2.13 ± 1.6） in parecoxib group and tramadol group （ P 〈 0.05 ）. The occurrence of nausea, vomiting and dizziness was respectively （ 10.2% ,5.6% ,5.7% ） and （23.7%, 16. 2% ,40.3% ） in parecoxib group and tramadol group （ P 〈 0.05 ）. Conclusion ： The successive PCIA-parecoxib combined with morphine have a favorable effect of analgesia on patients undergoing pedicle screw fixation, with less side-effects such as nausea, vomiting and dizziness.