吗啡和曲马多用于老年人术后PCEA的观察

To Compare the Efficacy of Morphine or Tramadol Combined with Bupivacaine on PCEA in Elderly Patient

目的 :比较吗啡、曲马多复合丁哌卡因用于老年人硬膜外术后病人自控镇痛 (PCEA)的镇痛效果和不良反应。方法 :选择 5 6例硬膜外麻醉下完成的下腹部或下肢手术病人 ,随机分为二组 ,每组 2 8例 :0 .12 5 %丁哌卡因10 0ml含吗啡 10mg(BM组 )、含曲马多 5 0 0mg(BT组 )。PCA设置 :负荷剂量 5ml,单次PCA剂量 1ml,连续输注速率 1.5ml/h ,锁定时间 2 0min。术后分别记录 2 4h用药总量、术后 4h、8h、12h和 2 4h进行视觉模拟评分(VAS)、镇静评分、恶心呕吐的发生率、并进行MAP、RR及SPO2 监测。结果 :二组病人各时点VAS评分和 2 4h用药量无显著差异 (P >0 .0 5 )。镇痛期间BP、RR稳定 ,SPO2 >94 %。但BM组皮肤瘙痒发生率明显高于BT组 (P <0 .0 1)。结论 :吗啡、曲马多复合丁哌卡因用于老年人PCEA效果确切、安全可靠。曲马多因其不良反应发生率低 。

Objective:To compre with the efficacy and the side effects of morphine or tramadol comined with bupivacaine for elderly patient during PECA.Methods:Fifty six patients for low abdominal or low limb surgery under epidural anesthesia were randomly divided in to two groups.Group BM∶0.125% bupivacaine+morphine(0.1 mg/ml).Group BT∶0.125% bupivacaine+tramadol(5 mg/ml).PCEA parameters were a loading dose of 5 ml,a bolus dose of 1 ml,continuous rate 1.5 m/h.lockout time 2 min.The total volume was recoded for up to 24 h after surgery,visual analogue pain scales(VAS),sedation scales,the pulse oximetry,incidence of nausea and vomitting,respiratory rate(RR),mean blood pressure(MAP) and were measured at 4 h,8 h,12 h and 24 h postoperatively.Results:There were no significant differences in the total volume and VAS between the two group.There was a significantly higher incidence of pruritus in group BM.Conclusions:Morphine or tramadol combined with bupivacatine used for elderly patiet PCEA get excellent analgesia and high safety.The method of elderly patient PCEA with tramadol has lower incidence of pruritus.