个体化曲马多术后病人自控静脉镇痛效应的研究

Effects of postoperative intravenous patient controlled analgesia with tramadol individualized

目的 :探讨疼痛敏感性与术后曲马多病人自控静脉镇痛 (PCIA)的量效关系。方法 :采用疼痛反应依赖性方法 ,筛选出 12 8例疼痛高敏和低敏感者 ,分为高敏和低敏患者组各设三个剂量治疗组 ,即按标准剂量分别设曲马多标准量组 (8.4mg·kg-1·d-1)和增减 10 %、2 0 %、30 %剂量组。采用PCIA技术实施术后镇痛 ,评价镇痛效果和患者满意度 ,记录一次药量输注时间 ,4 8h镇痛液总用量和不良反应。结果 :标准量对疼痛低敏者镇痛效果优于高敏者 (P <0 .0 5 ) ;高敏者增量 2 0 %和 30 %时 ,镇痛和药物用量指标均优于其标准对照组 (P <0 .0 1) ;低敏者减量30 %时疗效不佳 (P <0 .0 5 ) ;不良反应随剂量增加而加重 ,出汗表现明显 (P <0 .0 5 ) ,Ramsay评分均为Ⅱ～Ⅲ分。结论 :疼痛敏感性影响曲马多PCIA效果 ,高敏者增加标准量的 2 0 %及低敏者减少 10 %的剂量 ,术后镇痛效果更理想。

AIM: To study the dose-response relationship of painful sensibility and postoperative intravenous PCA (patients controlled analgesia) individualized with tramadol. METHODS:The 128 cases of patients (ASA I-III) with high painful sensibility and the low painful sensibility were screened out through a painful reaction-dependent manner. The high-sensibility cases were divided into four groups: standard-dose group (HSDG) (tramadol 8.4 mg·kg -1 ·24 h -1 ) and other three increased dose groups (increased by 10%, 20%, and 30%, respectively, based on the standard dose, n=16), and the low-sensibility cases were also divided into 4 groups: standard-dose group (LSDG) (tramadol 8.4 mg·kg -1 ·24 h -1 ) and other three decreased dose groups (decreased by 10%, 20%, and 30%, respectively). The effects of analgesia, the satisfactory degree and the adverse effects were evaluated during postoperative intravenous PCA. RESULTS: The analgesia effects in LSDG was significantly better than that in HSDG (P< 0.05 ). For cases with the high sensibility, the effects of analgesia in the increased dose groups (20% and 30%) were markedly better than that in HSDG (P< 0.01 ), but for cases with the low sensibility, the analgesia effects in decreased dose groups (30%) decreased (P< 0.05 ) in comparison with LSDG. The adverse effects, such as sweat, changed with the doses of tramadol increasing or decreasing. CONCLUSION: Painful sensibility influences the effects of tramadol intravenous PCA. For the patients with high sensibility, tramadol dose increased by 20% based on 8.4 mg·kg -1 ·24 h -1 can obtain the best effect, but for low sensibility, the dose should decreased by 10%.