静脉与硬膜外泵注曲马多病人自控镇痛的比较

Comparison of patient-controlled analgesia of intravenous with epidural tramadol

目的 比较术后静脉和经硬膜外应用曲马多病人自控镇痛 (PCA)的临床效果和安全性。方法 5 2例胸部和上腹部手术病人随机分为静脉注射曲马多病人自控镇痛 (PCIA)组和经硬膜外曲马多病人自控镇痛 (PCEA)组 ,每组 2 6例。两组曲马多负荷量为 1mg/kg ,PCA药物配方均为曲马多 60 0mg +氟哌利多 5mg + 0 9%氯化钠至 10 0ml,持续给药注速 2ml/h ,单次PCA剂量 0 5ml,锁定时间 15分钟。术后定时进行镇痛、镇静评分 ,2 4小时曲马多用量 ,患者满意度及不良反应的观察比较。结果 PCIA组 2 4小时用药量、按键次数及术后视觉模似评分 (VAS)均明显低于PCEA组 (P<0 0 5 )。两组镇静评分低且无明显差异。患者对术后镇痛总体满意程度良好至优秀均在 84 6%以上 ,不良反应发生率两组间无显著性差异。结论 曲马多用于术后镇痛安全有效。但曲马多PCIA镇痛效果明显优于曲马多PCEA ,且用药量少。

Objective To compare the effecacy and safety of patient contrdled analgesia (PCA) of intravenous with epidural tramadol.Methods 52 patients undergoing ordinary thoracic or epigastrial operation were randomly allocated to patient controlled intravenous analgesia (PCIA) group ( n= 26) or patient controlled epidural analgesia (PCEA) group ( n= 26).The PCA solution consists of tramadol 600mg,dropiridol 5mg and NS 86ml,Loading dose of tramadol was lmg/kg,and background infusion 2ml/kg,bolus 0 5ml,lockout time 15min.The severity of pain,incidence of nausea and vomiting,total dosage of tramadol used in 24h,and patient's satisfaition were assessed.Results The total dosage of tramadol administered,the times of temperarily pressing the PCA key and the postoperative pain scores were significantly lower in the PCIA group than those in the PCEA group.Between two growps,there was no significant difference in the overall satisfaction of pain relief,sedation and vomiting. Conclusions PCIA with tromadol is better than PCEA with it for postoperative pain relief.