老年患者左旋布比卡因曲马多术后硬膜外镇痛观察  

Levobupivacaine with Tramadol Used for Elderly Epidural Analgesia

作　　者：冉菊红[1] 马民玉[1] 李红[1] 

机构地区：[1]郑州大学第一附属医院麻醉科,郑州市450052

出　　处：《医药论坛杂志》2007年第1期3-5,共3页Journal of Medical Forum

基　　金：河南省科技攻关资助项目(0624420030)

摘　　要：目的观察左旋布比卡因复合曲马多用于术后老年患者自控硬膜外镇痛(PCEA)的效果及安全性。方法选择连续硬膜外麻醉下行下腹部、下肢手术患者40例,ASAⅡ-Ⅲ级,随机分为左旋布比卡因复合曲马多组(Ⅰ组,n=20)和罗哌卡因复合曲马多组(Ⅱ组,n=20)。术毕两组均连接微量止痛泵行PCEA 48h,镇痛液配制:Ⅰ组或Ⅱ组分别采用左旋布比卡因100mg或罗哌卡因100mg复合曲马多300mg加生理盐水稀释至100m l。采用Prince-Henry疼痛评分法评定镇痛效果,记录用药后3、6、12、24、48h疼痛评分,监测并记录相同时点BP、HR、ECG、RR和SpO2变化以及镇痛期间不良反应。结果两组患者术后各观察时点疼痛评分均<2分,组间比较差异无统计学意义(P>0.05),两组镇痛满意率为100%;各项监测指标与注药前比较差异无统计学意义(P>0.05),两组不良反应发生率均较低。结论0.1%左旋布比卡因复合0.3%曲马多用于老年患者术后PCEA可提供确切的镇痛效果,与罗哌卡因复合曲马多的效果相似,患者循环、呼吸功能均稳定,是一种安全有效的术后镇痛方法。Objective To observe the analgesic efficacy and safety of levobupivacaine with tramadol used for elderly patient - controlled epidural analgesia （PCEA）. Methods 40 elderly patients under continuous epidural anesthesia （ ASA grade Ⅱ -Ⅲ, undergoing elective lower abdominal or lower extremity operations） were randomly divided into two groups： levobupivacaine with ,ramadol Group（ Group Ⅰ, n = 20）and ropivacaine with tramadol Group （Group Ⅱ, n = 20 ）. After operation, the microdose analgesic pump was connected to epidural catherter in two groups for 48h. In Group I or Group Ⅱ ,levobupivacaine 100mg or ropivacaine 100mg with tramadol 300mg were diluted with normal saline to 100ml. The analgesic effect was assessed with Prince -Hennry scale,The changes of BP, HR, ECG, RR and SpO2 at 3,6,12,24,48h after injection were observed,the adverse reaction were also recorded. Results The analgesic scores at all time -points in two groups were less than 2 and there were no significant difference between two groups （ P 〉 0. 05 ）. The superior rate of analgesia are 100%. In two groups, the MAP, HR, ECG, RR and SpO2 had no significant difference compared with those before injection（ P 〉0. 05）. The incidence of adverse reaction in two groups was low. Conclusion The analgesic effect of 0. 1% levobupivacaine combined with 0. 3% tramadol for PCEA is definite. During analgesia ,the functions of patient‘s circulation and respiration are all stable. This analgesic method is safe and effective for postoperative pain in the elderly.

关 键 词：左旋布比卡因 曲马多 镇痛 硬膜外 老年 

分 类 号：R614.4[医药卫生—麻醉学]