曲马多与芬太尼PCSA用于心外科术后镇痛疗效的对比研究

Comparative study of Analgesic effect of Tramadol and Fentanyl PCSA in treatment of patients after cardiac surgery

目的：研究并讨论芬太尼PCSA与曲马多在心外科手术后的镇痛机制、临床疗效和安全性。方法：在ASAⅠ~Ⅲ级的心外科术后患者中抽取40例,将其分为芬太尼组和曲马多组各20例。芬太尼组的患者在心外科手术后给予利多卡因和芬太尼进行镇痛,曲马多组患者在心外科术后给予利多卡因和曲马多进行镇痛。PCA设置：单次剂量为1 ml,负荷量2 ml,限量是8 ml,其锁定时间为5 min。将药物在负荷量范围内注射完毕后开始记录的时间即为起效时间,同时记录气管导管拔除后12 h、24 h、36 h和48 h时间点的各项指标。结果：曲马多组镇痛的起效时间、有效按压次数和术后12 h的药物使用量均高于芬太尼组,差异有统计学意义（P〈0.05）。但两组患者对术后镇痛评价的满意度和术后24 h、48 h的有效按压次数间比较,差异无统计学意义（P〉0.05）。结论：芬太尼PCSA与曲马多在心外科手术后的镇痛疗效无明显的差异,但在手术结束的初始阶段,曲马多镇痛药物的消耗量显著多于芬太尼,且其不良反应也大于芬太尼,为降低不良反应多次少剂量注射曲马多镇痛药。

Objective To study and discuss the mechanism of fentanyl analgesic tramadol PCSA and after cardiac surgery,clinical efficacy and safety.Method To extract cardiac surgery patients ASAⅠ ~ Ⅲ level in 40 cases,were divided into groups and fentanyl tramadol group 20 cases.Fentanyl group of patients after cardiac surgery patients were given the drug lidocaine and fentanyl analgesia,tramadol in patients after cardiac surgery patients were given the drug lidocaine and tramadol analgesia.PCA settings：a single dose of 1ml,load 2 ml,limit was 8 ml,lock time was 5 min.After completion of drug injection in the load range starts recording time was the onset time,while recording 12 h,24 h,36 h and 48 h of the indicators point in time after extubation.Results The analgesic tramadol group onset time,effective compressions and drug use were higher than after 12 h of fentanyl group,There were significant differences between the two groups （P〈0.05） ,there were statistically significant.However,no significant difference between the two groups of patients satisfaction and postoperative evaluation of postoperative analgesia effective compression 24,48 h,so no statistical significance （P〉0.05） .Conclusion PCSA with fentanyl tramadol is not significant difference in heart analgesic efficacy after surgery,but in the initial stages of the end of surgery,the analgesic tramadol consumption was significantly greater than fentanyl,and its side effects is also greater than fentanyl,to reduce side effects of repeated low-dose injection should tramadol analgesics.