曲马朵复合地塞米松对腰椎钉棒系统内固定术后舒芬太尼镇痛效果的影响

Effects of tramadol combined with dexamethasone on postoperative analgesia with sufentanil after the operation of lumbar screw rod fixation system

目的观察曲马朵复合地塞米松对腰椎钉棒系统内固定术后舒芬太尼镇痛效果的影响。方法择期腰椎钉棒系统内固定手术患者132例，随机均分为曲马朵组（M组）、地塞米松组（D组）、曲马朵复合地塞米松组（MD组）与对照组（c组）。于切皮前分别注射上述药物，术毕均采用舒芬太尼患者静脉自控镇痛（PCIA）。观察并记录各组患者术毕与术后4、8、12、24和48h的VAS评分及Ramsay镇静评分，记录48h内患者PCA有效按压次数、舒芬太尼用量和术后不良反应。结果术后各时点MD组VAS评分及寒战发生率低于D、M、C组（P〈0．05）；MD组PCA有效按压次数、48h内舒芬太尼用量少于M、D、c组（P＜0．05），M组恶心、呕吐发生率高于D、MD、C组（P〈0．05）；术后Ramsay镇静评分4组比较差异无统计学意义（P〉0．05）。结论腰椎钉棒系统内固定术切皮前静脉注射曲马朵复合地塞米松可改善舒芬太尼术后镇痛效果，减少舒芬太尼用量，有效预防术后寒战反应。

Objective To observe the influence of tramadol combined with dexamethasone on the effects of sufentanil in postoperative analgesia after the lumbar screw rod fixation operation. Methods One hundred and thirty-two patients with lumbar screw rod fixation operation were ran- domly divided into four groups： tramadol group （group M）, dexamethasone group （group D）, tram- adol combined with dexamethasone group （group MD）, and control group （group C）. The drugs were injected before incising respectively and PCIA were used in all patients postoperatively, VAS and Ramsay sedation scores were recorded at the end of operation and 4, 8, 12, 24 and 24 h after op- eration. Results In each period, VAS and the incidence of shivering were significantly lower in group MD than those in group D, M and C （P〈0.05） ; The consumption of sufentanil and the press- ing times were fewer in group MD than those in group M, D and C （P〈0.05）; The incidence of nausea and vomiting was higher in group M than that in group D, MD and C （P〈0.05） ; There was no significant difference in Ramsay sedation score after the operation among the four groups （P〉0.05）. Conclusion Intravenous injection of tramadol and dexamethasone before incising during lum- bar screw rod fixation system operation can improve the postoperatively analgesic effect of PCIA with sufentanil, reduce the dosage of sufentanil and prevent postoperative shivering.