曲马多用于小儿术后镇痛最佳剂量的研究

Best regimen of tramadol PCA in pediatric patients

目的 探讨曲马多用于小儿术后镇痛的最佳剂量。方法 全身麻醉下择期手术患儿77例 ,年龄 1月～ 13岁 ,随机分为七组 :术毕经硬膜外注入曲马多负荷量 1mg/kg、维持量 0 15mg·kg 1·h 1(E1组 ) ;1 5mg/kg、0 2 2 5mg·kg 1·h 1(E1 5组 ) ;2mg/kg、0 3mg·kg 1·h 1(E2组 ) ;2 5mg/kg、0 375mg·kg 1·h 1(E2 5组 ) ;或静脉注入 1mg/kg、0 15mg·kg 1·h 1(I1组 ) ;1 5mg/kg、0 2 2 5mg·kg 1·h 1(I1 5组 ) ;2mg/kg、0 3mg·kg 1·h 1(I2组 )。选择持续输注加PCA给药模式 ,持续镇痛 4 8h。记录疼痛、镇静评分、曲马多用量、PCA按压次数、有效按压率 (D/D)及不良反应发生率。结果 曲马多用量依次为 :E2 5组 >E2组 >E1 5组 >E1组 ,I2组 >I1 5组 >I1组 (均P <0 0 1)。按压次数 :E1 5组明显少于E1组 (P <0 0 5 ) ,也明显少于I1 5组 (P <0 0 5 ) ,其余各组间无显著性差异。有效按压率 (D/D) :相同途径各组间均无显著差异。疼痛评分 :E2组明显低于E1组(P <0 0 5 ) ,其余各组间均无统计学意义。镇静评分及不良反应发生率各组间的差异均无统计学意义。结论 曲马多用于小儿术后镇痛 ,无论硬膜外途径还是静脉途径 ,负荷量 1 5～ 2mg/kg、维持量0 2 2 5～ 0 3mg·kg 1·h

Objective To find the best regimen of tramadol PCA in pediatric patients.Methods We randomized 77 patients undergoing elective abdominal surgeries ranging from 1 month to 13 years of age to 7 groups that received epidural or intravenous PCA infusion of tramadol after operation.Group E1,E1 5,E2 and E2 5 were the epidural groups and the loading doses were 1 mg/kg,1 5 mg/kg,2 mg/kg and 2 5 mg/kg respectively,they were also maintained in a dose of 0 15 mg·kg 1 ·h 1 ,0 225 mg·kg 1 ·h 1 ,0 3 mg·kg 1 ·h 1 and 0 375 mg·kg 1 ·h 1 respectively.Group Ⅰ1,Ⅰ1 5 and 12 were the intravenous groups.Their loading doses were 1 mg/kg,1 5 mg/kg and 2 mg/kg respectively and the maintenance rates were 0 15 mg·kg 1 ·h 1 ,0 225 mg·kg 1 ·h 1 and 0 3 mg·kg 1 ·h 1 respectively.Pain score,sedation score,tramadol consumption,pressing times,demand/delivery (D/D) and adverse effect were assessed for 48 hours.Results Tramadol consumption was in the following order:group E2 5>E2>E1 5>E1,group I2>I1 5>I1.Intra group differences were statistically significant( P< 0 01).Pressing times:in group E1 5(4 0±3 3) were much lower than those in group E1(19 7±23 1)( P< 0 05).The differences of pressing times among other groups were not significant.D/D of neither the epidural nor the intravenous groups had no any significant differences.Pain score of group E2(0 04±0 09) was significantly lower than that of E1(0 32±0 44)( P< 0 05),differences in pain score were not significant in other groups.Sedation score and adverse effect had no significant difference among all groups.Conclusion Infusion at the rate of 0 225 0 3 mg·kg 1 ·h 1 after a loading dose of 1 5 2 mg/kg is likely a good regimen of tramadol PCA in pediatric patients.