曲马多用于小儿术后硬膜外腔镇痛的临床研究

The Clinical Study of Using Tramadol for Postoperative Epidural Analgesia in Children

目的 :比较曲马多、哌替啶用于小儿硬膜外腔术后镇痛效果和副作用。方法 :对 80例 (ASAⅠ -Ⅱ级 )行硬膜外麻醉的患儿随机分成 4组行术后硬膜外腔镇痛。A组 (n =2 0 )曲马多 1 5mg/kg + 0 12 5 %布比卡因的镇痛液 5ml,B组 (n =2 0 )曲马多 1mg/kg + 0 12 5 %布比卡因的镇痛液 5ml;C组 (n =2 0 )哌替啶 0 75 %mg/kg+ 0 12 5 %布比卡因镇痛液 5ml;D组 (n=2 0 )单纯 0 12 5 %布比卡因 5ml。方法 :手术结束前给予镇痛液 ,观察给药后 30分钟内有血压心率、氧饱和度 (SPO2 )和呼吸频率 ,并记录疼痛完全缓解、明显缓解维持进间、镇痛效果、副反应。结果 :四组给药后 :BP、HR、RR无明显变化 ,C组 (哌替啶组 )SPO2 给药后由 97 2 %降至94 8%,而A、B、D三组SPO2 无明显改变。疼痛完全缓解时间A组 >C组 >B组 >D组 ,且曲马多用量越大 ,镇痛维持时间越长。恶心呕吐以A组为高 ,但组间无显著差异。结论 :曲马多的止痛效果、安全性 ,以及对呼吸抑制小可以使之成为小儿术后镇痛的有效替代剂 ,联合应用低浓度局麻药为小儿术后镇痛提供又一有效安全的选择。随着曲马多应用剂量的增大 (在推荐剂量下 )镇痛效果越好和维持时间越长 ,副反应也相应增加 ,这点 ,应给予注意。

WT5”BZ]The purpose was to compare the analgesic effects and side effect of tramadol and pethidine for postoperative epidural analgesia in children.Methods:Eighty children pediatrics patients undergoing epidural analgesia were randomized into 4 groups for postoperative epidural analgesia.Group A(n=2)were administrated with 5ml of 1 5mg/kg tramadol and 0 125% bupivacaine through epidural catheter.Group B(n=20) with 5ml of 1 0mg/kg tramadol and 0 125% bupivacaine,group C(n=20)with 5ml of 0 75% pethidine and 0 125% bupivacaine,group D(n=20)with 5ml of 0 125%bupivacaine.The prepared drugs were given to each group of patients accordingly just before the ending of surery.The HR,BP,SpO 2and RR were recorded within 30 minutes after amalgesia.The complete pain relief,maintaining time of pain relief,analgesic effects and side effects were also observed.Results:There were no significant changes in B.P.H.R.and RR.in all groups.The SpO 2 decreased from 97 2% to 94 8% in group C(pethidine),but there was no significant change in the other 3 groups.The order of complete pain relief time was:group A>group C>group B>group D.It was noted that the greater the dosage of tramadol,the longer the maintaining time of pain control.Nausea and vomiting occurred more frequently in group A,but there was no statistical difference among the 4 groups.Conclusion:Tramadol combining with local anesthetics was a safe and effective alternative for postoperative analgesia in chidren.The analgesic effects would become better and longer with increasing dosage of tramadol,but it must be alert that the sde effects might also increase. [WT5”HZ]