曲马多、芬太尼与氯诺昔康在鼾症患者术后镇痛的评价  

Analgesic effects of lornoxicam,tramadol and fentanyl in uvulopalatophargngiplasty surgery

作　　者：张旭[1] 白浪[1] 陈英子[1] 周守静[2] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院麻醉科,上海200031 [2]复旦大学附属华山医院麻醉科,上海200040

出　　处：《复旦学报（医学版）》2007年第4期580-583,共4页Fudan University Journal of Medical Sciences

摘　　要：目的以芬太尼为对照,观察氯诺昔康、曲马多不同药物配伍对悬雍垂-腭-咽成形术（uvulopalatophar-yngiplasty,UPPP）的患者行静脉自控镇痛（Patient-controlled an algesia,PCIA）的有效性和安全性。方法90例择期行UPPP的阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome,OSAS,即鼾症）患者,ASAⅠ~Ⅱ级,随机分为3组（n=30）,F组：芬太尼10μg/kg;FL组：芬太尼5μg/kg＋氯诺昔康0.4mg/kg;TL组：曲马多5mg/kg＋氯诺昔康0.4mg/kg;每组镇吐药物均为氟哌啶5mg,均以生理盐水稀释至100mL,背景剂量2mL/h,PCIA1.5mL/次,锁定时间15min。观察患者术后2、4、8、12、24h的视觉模拟评分值（VAS）和镇静效果（Ramsay评分）;记录患者血流动力学及通气功能的变化及恶心、呕吐、头晕、呼吸抑制、异常出血、尿潴留等不良反应。结果3组病人均镇痛良好。从VAS值和Ramsay评分来看,F组在术后2h镇痛效果好于FL组、TL组,但有镇静过度存在（P〈0.05）,其余时点3组效果无差异。血流动力学方面,与术前比较,F组、FL组患者MBP在术后2~4h有所下降（P〈0.05）;TL组患者MBP、HR、SPO2无明显变化（P〉0.05）;F组患者在术后2h MBP、HR、SPO2下降较其他两组显著（P〈0.01）。从不良反应来看,F组在呼吸抑制方面与其他两组有差异（P〈0.05）,恶心呕吐的发生率TL组略高于其它两组,但无统计学差异（P〉0.05）,其余不良反应发生率3组无显著差异。结论与使用芬太尼比较,曲马多复合氯诺昔康应用于鼾症患者的术后镇痛对呼吸影响小,更为安全。Purpose The purpose of this study was to evaluate the analgesic efficiency and safety of patient-controlled analgesia （PCIA） effects with lornoxicam, tramadol and fentanyl following uvulopalatopharyngiplasty （UPPP） surgery. Methods Ninety ASA Ⅰ -Ⅲ patients undergoing UPPP surgery were randomly divided into three groups： F group （fentanyl 10 μg/kg） ,FL group （fentanyl 5 μg/kg＋ lornoxicam 0.4 mg/kg） ,or TL group （tramadol 5 mg/kg ＋ lornoxicam 0.4 mg/kg）. The drugs were diluted with normal saline to 100 mL （background 2 mL/h, PCIA bolus 1.5 mL, lockout time 15 min）. The efficiency analgesic effects were assessed by Visual Analogue Scale （VAS） and Ramsay score at 2,4, 8, 12,24 hour after operation. The circulatory, ventilatory function and side effects were also recorded. Results All of these 3 groups showed good pain relief. In group F,VAS and Ramsay score were lower than those of the other two groups at 2 h （P〈0.05）. Comparing with the base point： in F and FL group,MAP,HR and SPO2 were lower at 2-4 h （P〈0.05） ,significantly in F group （P〈0.01） ; They showed no differences in TL group （P〉0.05）. The respiratory depression was significantly lower in F group than that of the other two groups （P〈0.05）. There were no significant differences in other side effects in 3 groups （P〉0. 05）. Conelnsions Postoperative patienton-trolled intravenous analgesia with lornoxicam combined with tramadol may be the preferred analgesic following UPPP surgery.

关 键 词：曲马多 氯诺昔康 芬太尼 静脉自控镇痛 阻塞性睡眠呼吸暂停综合征 悬雍垂-腭-咽成形术 

分 类 号：R614.2[医药卫生—麻醉学]