舒芬太尼或曲马多用于椎管内肿瘤切除术后镇痛的比较

A comparative study on postoperative analgesia with sufentanil or tramadol after interspinal tumor surgery

目的探讨舒芬太尼或曲马多病人自控静脉镇痛(PCIA)用于椎管内肿瘤切除术后的镇痛效果及不良反应。方法 ASA分级I^II级、18~65岁、拟行后正中入路椎管内肿瘤切除术、自愿接受术后镇痛患者150例,随机双盲分为舒芬太尼组(S组,n=75)和曲马多组(T组,n=75)行术后PCIA。S组:舒芬太尼150μg+盐酸托烷司琼10 mg+生理盐水稀释成100 ml;T组:曲马多1000 mg+盐酸托烷司琼10 mg+生理盐水稀释成100 ml。镇痛泵设置均为2 ml/h,PCA 0.5 ml,间隔15 min。开始镇痛后2 h、16 h、24 h和48 h观察并记录患者的VAS疼痛评分、Ramsay评分及瘙痒、恶心、呕吐和头晕的发生情况。结果两组患者术后各时间点VAS评分、Ramsay评分及恶心、呕吐、瘙痒、头晕的发生率差异无统计学意义(P>0.05)。S组和T组术后16 h、24 h和48 h VAS在0~3分的比率分别为69.3%比69.3%、74.7%比80.0%、84.0%比84.0%。结论舒芬太尼或曲马多PCIA用于椎管内肿瘤切除术后,均可提供一定程度的镇痛,且不良反应发生率无显著差异,可作为术后镇痛的选择。但以上两种方法均有部分患者镇痛不全,如何完善椎管内肿瘤患者术后镇痛尚有待于进一步研究。

Objective To explore the analgesic effect and adverse reactions of sufentanil or tramadol for control of intravenous ana （PCIA） after interspinal tumor surgery. Methods 150 patients with ASA I ？II, 18 ？65 y old, suffering from interspinal tumor surgery were randomized, double - blind assigned to receive intravenous analgesia with either sufentanil （ group S, n = 75） or tramadol （group T, n = 75）. The analgesic drug in group S was sufentanil 150[xg and tropisetron hydrochloride 10 mg in 100ml normal saline. The drug applied in group T was tram-adol 1000 mg and tropisetron hydrochloride 10 mg in 100 ml normal saline. The analgesia pumps were set at 2 ml/h, PCA 0.5 ml, at 15 min in-tervals. The VAS scores, Ramsay scores and the incidence of pruritus, nausea, vomiting and dizziness were observed at 2 h, 16 h, 24 h and 48 h after surgery. Results There was no significant difference in VAS scores, Ramsay scores and the incidence rates of pruritus, nausea, vomiting and dizziness between these two groups （ P 〉 0 .0 5 ） . The incidence of patients with VAS 0 ？3 in two groups at 16 h , 24 h and 48 h after surgery were 69. 3% versus 69. 3% , 74. 7% versus 80. 0% , and 84.0% versus 84. 0% . Conclusion The application of patient controlled intravenous analgesia （PCIA） with sufentanil or tramadol can be a choice after interspinal tumor surgery due to these two methods can provide certain analgesi-a, and there is no difference in incidence of adverse reactions. However, there are some patients using the above two methods had uncompleted an-algesia ,hence how to perfect postoperative analgesia after interspinal tumor surgery remained to be further study.