曲马多,布比卡因,吗啡不同配伍术后PCEA效果及不良反应比较

Comparison of the Effects and Side-effects of PCEA with Different Combination of Bupivacaine,Morphine and Tramadol

目的 :比较曲马多 ,布比卡因 ,吗啡不同复合作PCEA的镇痛效果。方法 :随机选取 45例病人分为三组。M组 (0 .0 0 5 %吗啡 +0 .1%布比卡因 ) ,T组 (单纯 0 .6 %曲马多 ) ,C组 (0 .4%曲马多 +0 .1%布比卡因 )。比较VAS ,D/D比值 ,有效按压次数 ,实际按压次数 ,肠道蠕动恢复时间 ,72h用药量 ,以及眩晕发生率、呕吐、嗜睡等并发症。结果 :三组病人在手术后 72h中的镇痛效果均较好。VAS评分均低于 4。M组较其他组有显著差异 (P <0 .0 1)。T组和C组VAS评分无显著差异 (P >0 .0 1)。D/D比值各组均为 1左右 ,无显著差异 (P >0 .0 1)。实际按压数、有效按压数各组之间无差异 (P >0 .0 1)。肠道蠕动恢复时间为T组 (33.75± 6 .95 )≈C组 (31.2± 8.6 3) <M组 (4 9.85± 9.36 )。有显著差异 (P <0 .0 1)。眩晕发生率T组 (5 3.33% ) >C组 (6 .6 7% )。T组和C组无 1例发生嗜睡和皮肤瘙痒。M组嗜睡 (2 6 .6 7% )、皮肤瘙痒 (13.33% )、呕吐 (13.33% )。结论 :曲马多用于术后镇痛治疗的效果较确切 ,其作用相对较吗啡弱 ,但并发症少 ,无恶心呕吐 ,皮肤瘙痒 ,嗜睡 ,对肠道蠕动恢复影响较吗啡小。在临床使用中安全性较高。曲马多的不良反应是与剂量相关的晕眩 ,曲马多、布比卡因复合应用及适当调整剂量 。

Objective: We compared patient-controlled epidural analgesia (PCEA) effect with different combination of bupivacaine, morphine and tramadol. Methods: Forty five patients were divided into 3 groups i.e., Group M(0.005% morphine + 0.1 bupivacaine),Group T (0.6% tramadol alone ), Group C (0.4% tramadol + 0.1 bupivacaine ), we studied VAS ,D/D ratio, demand times and delivery times , enterokinetic recovery time, drug dose in 72 hours, and the side-effects such as dizziness, nausea and sedation. Results: In all groups, the effect of pain control was assuredl in 72 hours. VAS<4. But the effect of group M was better than other groups ( P <0.01). Enterokinetic recovery time in these groups was: group T (33.75±6.95)≈group C (31.2±8.63)<group M(49.85± 9.36 ). The ratio of dizziness was: group T (55.33%)>group C (6.67%). No one in group T and in group C had nausea and sedation and itching. The side-effects of group M were: sedation (26.67%),itching (13.33%),nausea(13.33%). Conclusion: The PCEA pain control of tramadol is assured and safe in the post-operation. The side-effects are less. Patients who used tramadol or tramadol combined with bupivacaine did not have sedation, nausea and itching . But compared with morphine, the effect of pain control in these groups was lower. And some patients had dizziness. But the enterokinetic recovery time is shorter than morphine. Combined with Bupivacaine, the effect of pain control can be increased and the side-effects can be decreased.