硬膜外注射曲马多和咪唑安定用于术后镇痛效果观察

Epidural tramadol and midazolam injection for the analgesia after abdominal operation

目的 :观察硬膜外注射曲马多和咪唑安定用于腹部手术术后镇痛效果、不良反应和对血流动力学及呼吸的影响。方法 :随机选择 40例连续硬膜外麻醉下行中、下腹部手术患者 ,ASAⅠ～Ⅱ级。分为 2组 ,Ⅰ组 (曲马多和咪唑安定组 ) 2 0例 ;Ⅱ组 (曲马多组 ) 2 0例。于关腹时 ,Ⅰ组将曲马多 10 0ml和咪唑安定 2 .5mg ,用生理盐水稀释至 10ml;Ⅱ组将曲马多 10 0mg用生理盐水稀释至 10ml,均一次缓慢注入硬膜外腔。监测注药后 10min ,2 0min和30min的平均动脉压 (pMA)、心率 (fH)、血氧饱和度 (xO2 )、呼吸频率 (fR)和心电图 (ECG)变化。PrinceHennry疼痛评分标准评价镇痛效果 ,同时记录镇痛时间及不良反应。结果 :Ⅰ组镇痛评分为 (1.2 5± 1.10 ) ,疼痛完全缓解率为85 % ,Ⅱ组评分为 (1.75± 1.12 ) ,疼痛完全缓解率为 75 %。镇痛完全时间Ⅰ组为 (15 .4± 4.4)h ,Ⅱ组为 (10 .9± 0 .9)h ,Ⅰ组明显长于Ⅱ组 (P <0 .0 1)。监测各项指标与注药前比较差异无显著性 (P >0 .0 5 )。 2组患者均未发现肺部并发症及心律失常。结论 :术后硬膜外注入曲马多和咪唑安定可提供确切的镇痛效果 ,且患者呼吸及循环功能稳定 。

Aim:To observe the analgesic effect and adverse reaction of epidural tramadol and midazolam injection, and the influence on hemodynamic and respiration in patients after abdominal operation. Methods: A total of 40 patients (ASAⅠ～Ⅱ, undergoing elective middle and low abdominal operations) were randomly divided into 2 groups: GroupⅠ (tramadol and midazolam group, n =20) and GroupⅡ ( tramadol group, n =20). When closing the abdominal cavity, 10 ml analgesic solution in 2 groups was slowly injected to epidural space. In GroupⅠ,tramadol 100 mg and midazolam 2.5 mg were diluted with normol saline, while in GroupⅡtramadol 100 mg diluted. The changes of p MA , f H, x O 2 , f R and ECG at 10 min, 20 min and 30 min after injection were observed. The analgesic effect was assessed with Prince Hennry scale. The analgesic time and adverse reactions were also recorded. Results: In Group I and Ⅱ, the analgesic scores were (1.25±1.10) and (1.75±1.12) respectively. The remission rates of pain were 85% and 75% respectively. The analgesic time of Gronp Ⅰ was markedly longer than that of Group Ⅱ( P <0 1). In 2 groups, the p MA , f H, x O 2 , f R and ECG had no significant differences compared with those before injection ( P >0.05). The pulmonary complications and arrhythmia hadn't found in all patients. Conclusion: The analgesic effect of epidural tramadol and midazolam injection is definate. The functions of respiration and circulation of patients are all stable. This analgesic method is safe and effective for postoperative pain.