盐酸曲马多在术后自控镇痛与超前镇痛中的应用效果比较

Comparsion of the effects between postoperative patient-controlled analgesia and preemptive analgesia by tramadol hydrochloride

目的对比盐酸曲马多在术后自控镇痛(PCA)与超前镇痛(PA)中的应用效果。方法选择2011年8月到2015年2月择期行全身麻醉下开腹手术患者98例,根据随机抽签原则分为PA组与PCA组,各49例。PCA组给予盐酸曲马多术后PCA,PA组给予盐酸曲马多PA。结果 2组的呼吸恢复时间、唤醒时间和拔管时间对比差异都无统计学意义(P>0.05)。PA组麻醉前、拔管前与拔管后24 h的疼痛评分分别为(2.13±0.45)分、(2.22±0.51)分和(1.89±0.45)分,而PCA组分别为(2.22±0.34)分、(2.31±0.41)分和(2.00±0.52)分,组间对比差异均无统计学意义(P>0.05)。2组拔管前与拔管后24 h的心率与血压都明显高于麻醉前,不过PA组拔管前与拔管后24 h的心率与血压明显低于PCA组(P<0.05)。PA组与PCA组拔管后24 h的恶心呕吐发生率分别为2.0%和14.3%,PA组明显低于PCA(P<0.05)。结论相对于术后PCA,曲马多在PA的应用能有效保持麻醉与镇痛效果,更好地促进血流动力学的稳定,减少恶心呕吐的发生,有很好的应用价值。

AIM To compare the effects between postoperative patient-controlled analgesia （PCA） and preemptive analgesia （PA） by tramadol hydrochloride. METHODS From August 2011 to February 2015, the selected 98 patients underwent elective laparotomy under general anesthesia. Accorded to the random draw principle the patients were equally divided into PA group and PCA group, the PCA group were received postoperative patient-controlled analgesia by the tra- madol hydrochloride, and the PA group were received tramadol hydrochloride preemptive analgesia. RESULTS The breathing recovery time, wake-up time and extubation time were compared between 2 groups, and there were no statistically significant differences （ P 〉 0.05）. The pain scores in the PA group of before anesthesia, before extubation and post-extubation 24 h were （2.13 ±0.45） points, （2.22± 0.51 ） points and （ 1.89±0.45） points respectively, and in the PCA group were （2.22 ±0.34） points, （2.31 ± 0.41 ） points and （2.00± 0.52） points respectively. The differ- ences between 2 groups were not statistically significant （ P 〉 0.05）. The heart rate and blood pressure at before cxtuba- tion and post-extubation 24 h in 2 groups were significantly higher than before anesthesia, but the PA group at before ex- tubation and post-extubation 24 h were significantly lower than the PCA group （ P 〈 0.05）. The incidence of nausea and vomiting at post-extubation 24 h were 2.0% and 14.3 % respectively , but the PA group was significantly less than the PCA group （ P 〈 0.05）. CONCLUSION Compared to postoperative PCA, tramadol hydrochloride preemptive analgesia application can effectively maintain anesthesia and analgesic effects. It can better promote hemodynamic stability, reduce the incidence of nausea and vomiting that has very good application values.