曲马多复合芬太尼在小儿术后持续静脉镇痛中的应用  

Postoperative intravenous analgesia with a combination of tramadol and fentanyl continuously infused in children

作　　者：周碧云[1] 罗爱林[1] 喻红辉[1] 田玉科[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉学教研室,湖北武汉430030

出　　处：《中国妇幼保健》2007年第32期4618-4621,共4页Maternal and Child Health Care of China

摘　　要：目的：比较曲马多与不同剂量芬太尼复合用于小儿术后持续静脉自控镇痛（PCIA）效果和副作用。方法：选择行全麻择期手术患儿120例（ASAⅠ～Ⅱ级）进行术后PCIA，随机分成四组：T组：1％曲马多；TF1组：1％曲马多＋芬太尼2μg·ml^-1；FT2组：1％曲马多＋芬太尼4μg·ml^-1；TF3组：1％曲马多＋芬太尼6μg·ml^-1。手术缝皮时开启镇痛泵，负荷量0．1ml·kg^-1 ＋持续量0．5^-1ml·h^-1，＋PCA量0．5^-1 ml^-1次。（由患儿双亲或护士控制，NPCIA／PPCIA），锁定时间10min。均静脉注射格拉司琼40μg·k^-1。记录术后24h内的血压、心率、脉氧饱和度（SPO2）、呼吸频率（RR）、CHEOPS（Children＇s Hospital of Estem Ontario Pain Score）镇痛评分〈4分：无痛，〉6分：中度疼痛，〉13分：重度疼痛）、表情疼痛评分（FRS）、TSS镇静评分、24h用药量以及不良反应。结果：四组术后24h的BP、HR、呼吸频率（RR）无明显变化，均可达到满意的镇痛效果，FRS各组间的差异无显著性（P〉0．05），T组和TF1组HEOPS在术后30min时明显降低（P〈0．05）；24h曲马多用量T组〉TF1组〉TF2组（P〈0．05），TR组〉TF3组，但差异无统计学意义（P〉0．05）；按压次数（PCAe）、术后恶心呕吐（PONV）发生率四组间的差异无显著性，TF3组术后苏醒时间较另三组明显延长，各组内均有一例患儿出现眩晕。结论：小剂量芬太尼与曲马多复合用于小儿PCIA镇痛效果良好，可明显减少曲马多的用量，最佳方案是镇痛用药为1％曲马多＋芬太尼4μg·ml^-1，负荷量0．1ml·kg^-1 ＋持续量0．5^-1ml·h^-1 ＋PCA0．5～1ml；格拉司琼在小儿中的应用尚需进一步的研究。Objective： To compare the efficacy of patient - controlled intravenous analgesia （PICA） with a eo - application of different dosage of tramadol and fentanyl in postoperative analgesia in children. Methods： By an observer -blinded design, 120 ASA Ⅰ-Ⅱ pediatrle patients （1 ～ 12 years old） underwent general anesthesia were randomly given a postoperative intravenous infusion of 1% tramadol （ Group T）, 1% tramadol plus fentanyl 2 μg/ml （ Group TF1 ） , 1% tramadol plus fentanyl 4 μg/ml （ Group TF2 ） , or 1% tramadol plus fentanyl 6μg/ml （ Group TF3 ） . Exclusion erlteria included children with mental disorders, hypothyroidism pilepsy, and long - term analgesic users. All the patients received Granisentran Hydrochloride 40 μg/kg via intravenous injection at the end of surgery. PCIA was commenced and continued for 24 h. The analgesic effect was assessed by Wong- Baker Faces Pain Rating Scale （FRS） and the Children＇s Hospital of Ontario Pain Scale （CHEOPS）, less than 4 （no pain）, more than 6 （moderate pain）, more than 13 （severe pain）, eousumption of analgosies and the ineideneos of side - effects were recorded. Results： （ 1 ） There were no significant differences in the demographic data ineluding sex, age, body weight, types of surgery and duration of operation among the four groups （ P 〉 0. 05 ） ; （ 2 ） No significant differenees were found in BP, HR, RR （respiratory rate） and SpO2 among the four groups （P 〉0. 05） ; （3） The FRS did not significantly change among the four groups, and the CHEOPS at the point of 30 min were significantly decreased in both group T and group TF1 ; （4） With the dosages of fentanyl increased, the 24 h consumptions of tramadol were significantly reduced in Group T , Group TF1 and Group TF2 （P 〈0. 05）, but the tendency was disturbed in Group TF3; （5） The incidences of vertigo, nausea and vomiting had no significant differenees among the four groups, while the recovery time of Group TF3 was sig

关 键 词：小儿 静脉镇痛 CHEOPS评分 曲马多 

分 类 号：R971[医药卫生—药品]