等效剂量曲马多、吗啡或芬太尼用于老年病人术后静脉镇痛的临床研究

Clinical study of equivalent tramodal,morphine or fentanyl for continuous intravenous postoperative analgesia in elderly patients

目的 研究等效剂量曲马多、吗啡或芬太尼用于老年病人术后静脉镇痛的临床疗效。方法 12 0例老年病人 ,随机分为三组 ,每组 4 0例。术后病人第 1次感到疼痛时 ,给予等效初始量曲马多 1 5mg/kg(T组 )、吗啡 0 15mg/kg(M组 )、芬太尼 1 5 μg/kg(F组 )静注 ,然后分别持续静注曲马多 10mg·2ml-1·h-1、吗啡 1mg·2ml-1·h-1或芬太尼 10 μg·2ml-1·h-148小时。记录镇痛期间 1、2、3、4、6、12、2 4、4 8小时静息及活动时疼痛VAS值 ;监测用药前及用药后 10、2 0、30分钟、用药后 1、2小时的RR、SaO2 变化及各种不良反应。结果 三组病人静息时镇痛效果无明显差异 (P >0 0 5 )。前 4小时活动时M组、F组镇痛效果较T组优 (P <0 0 5 ) ;用药后 10、2 0分钟M组、F组RR明显减慢 ,与用药前相比差异显著 (P <0 0 5 ) ,所有病例用药前与用药后SaO2 均保持正常 ;恶心、呕吐的发生率T组明显高于M组、F组 (P <0 0 5 )。结论 连续静注等效剂量曲马多、吗啡或芬太尼用于老年病人术后镇痛均能取得满意的镇痛效果 ,但活动时吗啡和芬太尼的镇痛效果优于曲马多 ;吗啡和芬太尼于首次用药后能引起短暂的呼吸抑制 ,但在持续给氧时SaO2

Objective To study clinical efficacy of equivalent dose of tramadol,morphine or fentanyl for continuous intravenous postoperative analgesia in elderly patients.Methods One hundred twenty aged patients were randomly divided into three groups.When patients complained of pain in the recovering room,equivalent initial dose of tramodal 1 5mg/kg(group T), morphine(group M) or fentanyl(group F) was administered,then the patient was respectively treated with intravenous tramadol 10mg·2ml -1 ·h -1 (group T), morphine 1 0mg·2ml -1 ·h -1 (group M) or fentanyl 10μg·2ml -1 ·h -1 (group F) for 48h.The pain intensity(VAS) of everyone at rest and movement was recorded,before administration and at 1,2,3,4,6,12,24,48h after administration.SaO 2,RR,BP and ECG were continuously monitored.Side effects were also recorded.Results There were no significant differences of pain intensity among three groups at rest( P> 0 05).However the efficacy of analgesia of group M and group F was better than that of group T during movement at first four ( P< 0 05).Respiratory rate was significantly decreased at 10 and 20 min compared with that before any administration in group M and F( P< 0 05).SaO 2 of all patients was normal throughout postoperative period.The incidence of nausea and vomiting was more in group T than that in group M and group F( P< 0 05).Conclusion Continuous intravenous infusion of equivalent dose of tramadol,morphine or fentanyl can all provide effective analgesia for postoperative pain in elderly patients,but during movement morphine or fentanyl is better than tromadol.After loading dose there is transient respiratory depression in group M and group F,however,SaO 2 is normal. [