曲马多与芬太尼PCSA用于心外科术后镇痛疗效的对比研究

Compared Study on Tramadol and Fentanyl via Subcutaneous PCA Following Cardiac Surgery

目的 :评价曲马多与芬太尼经皮下病人自控镇痛 (PCSA)的疗效、安全性及实用性。方法 :将21例ASAI～III级心外科术后病人随机分为曲马多 (T)组与芬太尼 (F)组 ,其中T组10例 ,F组11例。F组药物为芬太尼25mg/L和利多卡因10g/L的混合液 ,T组药物为曲马多10g/L和利多卡因10g/L的混合液。PCA设置 :负荷量2mL ,单次剂量1mL ,限量8mL/h ,锁定时间5min。负荷量注射完后记录镇痛起效时间 ,拔除气管导管后12 ,24 ,36 ,48h记录各项指标。结果 :两组镇痛起效时间 ,术后12h药物用量及有效按压次数T组多于F组 ,两组比较有显著性差异 (P<0.05或P<0.01) ,术后24 ,36,48h有效按压次数、镇痛满意度无显著性差异(P>0.05)。结论 :芬太尼与曲马多PCA的疗效无显著性差异 ,术后初始镇痛曲马多消耗量明显增加 ,而副作用也随之增加 ,缩短锁定时间 ,适当降低单次剂量 ,增加有效按压次数 。

Objective:To evaluate the efficacy and safety of tramadol and fentanyl for releasing pain after cardiac surgery with subcutaneous PCA(PCSA).Methods:Twenty_one patients with preoperative cardiac funcˉtion of ASA I～III were randomly divided into two groups after cardiac surgery which included tramadol group(n=10)and fentanyl group(n=11).The mixture of tramadol(10g/L)and lidocaine(10g/L),fentanyl(25mg/L)and lidocaine(10g/L)were respectively given in tramadol group and fentanyl group.PCSA setting:loading dose of2mL,bolus dose of1mL,hour limit of8mL/h,and lockout time of5minutes were set.Patients with pain score above3on Visual Analog Scale8hours after extubation and without any contraindications of PCA were enrolled in this study.The following variables were recorded at intervals of12,24,36,and48hours after extubation.Results:There was a significant difference in onset of analgesia and drug dose at12hours between tramadol group and fentanyl group(P<0.05).There was no significant difference in sexual distribution,status of drink,incidence of nausea and vomiting,level of education,analgesia efficacy,sedation,patient satisfaction,recovering time of gut motility,and postoperative hospitalization(P>0.05).Conclusion:There was no signifiˉcant difference in monitoring target and the incidence of side effect between two groups.The present study confirmed that PCSA administration of tramadol could provide effective analgesia following cardiac surgery.