纳络酮复合曲马多静脉自控镇痛的研究  

Study of naloxone combined with tramadol in patient-controlled intravenous analgesia

作　　者：季永[1] 吴志刚[1] 李宗权[2] 

机构地区：[1]遵义医学院附属医院 [2]成都市第六人民医院麻醉科,四川成都610051

出　　处：《遵义医学院学报》2004年第2期128-130,133,共4页Journal of Zunyi Medical University

摘　　要：目的　比较曲吗多复合纳络酮和单纯曲吗多用于病人自控术后镇痛的疗效及不良反应 ,分析曲吗多术后镇痛不良反应发生的机理。方法　选ASAⅠ～Ⅱ级手术病人 75例 ,随机分为 3组 ,每组 2 5例 :空白对照组 (A)、曲马多复方镇痛组 (B)、纳络酮复合曲马多复方镇痛组 (C)。手术后B组予曲吗多 15mg·kg-1、C组予曲吗多 15mg·kg-1复合纳洛酮 0 .8mg用于病人静脉自控镇痛 (PCIA)泵行术后镇痛 ,随访 4 8h记录各时点血压、心率、呼吸频率、动脉氧饱和度、VAS评分、Ramesay镇静评分 ,观察比较尿滁留、皮肤瘙痒等不良反应的发生率。 结果　两治疗组均有较好的镇痛效果 ,各时点VAS评分与对照组有极显著差异 (P <0 .0 1) ,两治疗组各时点VAS评分无差异 ;两治疗组比较 ,C组未见过度镇静、呼吸抑制、尿滁留、呕吐等严重并发症 ,恶心、嗜睡发生率明显低于B组 (P <0 .0 5 ) ,与对照组比较无差异。结论　小剂量纳络酮复合曲马多用于术后镇痛 ,能消除不良反应 ,而且又不影响其镇痛效果。Objective To value the postoperative analgesic effects and adverse effects of PCIA with tramadol compared with naloxone combined with tramadol, analyses the possible mechanism of tramadol side effects. Methods 75 cases ASA Ⅰ～Ⅱ degree patients were randomly divided into three groups,25 cases each group :group A (normal control ) without any analgesic ;group B :PCIA with tramadol 15mg /kg and group C: PCIA with naloxone 0.8mg combined with tramadol . The following data were recorded within 48 hours after operation: heart rate(HR),blood pressure( SBP),respiration(RR),pulse oxygen saturation (SpO 2),Ramesay sedation score(SS ),visual analogue scales(VAS),postoperation nausea,vomiting,prutitus,lethargy and respiration depression. Results Significant differences were found in RSS and VAS when group B、C compared with A (P<0.01),there were no significant differences between group B and C; Statistical differences were found in the occurrence of nausea and lethargy between group C and B(P<0.05),there were no vomiting,prutitus,respiration depression and over sedation in group C ,the occurrence of adverse effects between group A and C had no statistical differences. Conclusions low dose naloxone combined with tramadol PCIA had the same satisfied analgesic effect with tramadol single ,but with little adverse effects.

关 键 词：曲马多 纳洛酮 静脉 病人 自控镇痛 不良反应 

分 类 号：R641.2[医药卫生—外科学]