曲马多复合芬太尼用于椎间盘髓核摘除术后患者自控静脉镇痛疗效观察  

Observation on therapeutic effect of tramadol combined with fentanyl in patient controlled intravenous analgesia after nucleotomy of intervertebral disc

作　　者：秦丽文[1] 郑良杰[1] 郝国明[1] 张舟[1] 张长椿[1] 

机构地区：[1]汕头市中心医院麻醉科,广东省汕头515031

出　　处：《中国基层医药》2006年第7期1107-1108,共2页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的观察曲马多复合芬太尼用于椎间盘髓核摘除术后患者自控静脉镇痛(PCIA)的临床效果。方法随机将60例在全身麻醉下行椎间盘髓核摘除术的患者分为曲马多(T)组、芬太尼(F)组和曲马多+芬太尼(TF)组各20例。三组患者均行术后PCIA,采用负荷剂量+背景剂量+PCA给药模式。术后6、12、24、48h分别观察BP、HR、RR、镇痛效果VAS评分,记录术后24h镇静程度评分、48h用药量和PCA平均按压有效次数,观察恶心呕吐发生情况。结果三组患者间BP、HR、RR、镇痛效果VAS评分差异无统计学意义。术后48hPCA平均按压有效次数T组(14±3)次,F组(12±3)次,TF组(8±2)次,TF组与其他两组对比差异有统计学意义(P<0·05)。48h用药量:T组曲马多(17·9±1·5)mg/kg、F组芬太尼(16·8±1·5)μg/kg、TF组曲马多(11·5±0·7)mg/kg+芬太尼(9·1±0·7)μg/kg,TF组与T组、F组比较差异有统计学意义(P<0·05)。术后24h镇静评分F组与T组、TF组比较差异有统计学意义(P<0·05)。术后24h恶心呕吐的发生率T组高于其他两组,T组与F组、TF组比较差异有统计学意义(P<0·05)。结论曲马多和芬太尼用于椎间盘髓核摘除术后PCIA可提供同样满意的镇痛效果,但曲马多恶心呕吐的发生率高,而芬太尼的镇静作用发生率高;曲马多联合少量芬太尼能提供满意的镇痛且具有用药量少和不良反应少的优势。Objective To observe the therapeutic effect of tramadol combined with fentanyl in patient controlled intravenous analgesia after nucleotomy of intervertebral disc. Methods 60 patients under general anesthesia, scheduled for nucleotomy of intervertebral disc, were randomly divided into three group （ n = 20） ： group tramadol （group T）, group fentanyl （ group F） and group tramadol ＋ fentanyl （group TF）. All patients were received patient controlled intravenous analgesia by loading dose ＋ background dose ＋ PCA bolus dose. The BP, HR, RR, VAS at 6, 12,24,48h of postoperation were observed. The sedation score in 24h, average effective-press times and drug dose in 48h of postoperation were recorded. The incidence of nausea and vomiting during 24h of postoperation were observed. Results It had no significantly difference of BP, HR, RR, VAS among three groups. The average effectivepress times of group TF （8 ± 2） were significantly less than those of group T （14 ± 3） and group F （12 ± 3）. The drug dose of 48 h was tramadol （ 17.9 ± 1.5 ） mg/kg（group T）, fentanyl （ 16.8 ± 1.5 ） μg/kg（group F） and tramadol （ 11.5 ± 0.7 ） mg/kg ＋ fentanyl （9.1 ± 0.7 ） μg/kg（group TF）. The drug dose of group TF showed significant difference compared with others. The sedation score in group F was the highest, it had significant difference compared with the other two group. The frequency of nausea and vomiting in group T was significantly more than that in oth- ers. Conclusion Tramadol or fentanyl gived alone can afford the same satisfied analgesic effect on nucleotomy of intervertebral disc. But there is high nausea-vomiting frequency in tramadol and strong sedation frequency in fentanyl. Tramadol combined with a little opioid fentanyl can afford more satisfying analgesic effect, and is provided with advantage in less drug and side-effect.

关 键 词：镇痛 病人控制 输注 静脉内 曲马多 芬太尼 

分 类 号：R614[医药卫生—麻醉学]