罗哌卡因伍用哌替啶、吗啡或曲马多用于术后硬膜外自控镇痛效果的比较  

Combination of ropivacaine with pethidine,morphine or tramadol for postoperative PCEA

作　　者：陈艳红[1] 许霁虹[2] 张铁铮[2] 刘晓江[2] 

机构地区：[1]康平县人民医院麻醉科,辽宁康平110500 [2]沈阳军区总医院麻醉科,沈阳110016

出　　处：《实用药物与临床》2009年第3期173-174,共2页Practical Pharmacy and Clinical Remedies

摘　　要：目的对比观察罗哌卡因伍用哌替啶、吗啡或曲马多用于术后硬膜外自控镇痛(PCEA)的效果及不良反应。方法选择ASAⅠ～Ⅱ级择期行下腹部或下肢手术的患者90例,随机分为罗哌卡因复合哌替啶(A组)、复合吗啡(B组)和复合曲马多(C组),各30例,分别于用药后4、8、24和48h观察血压、心率、脉搏血氧(SpO2)、疼痛视觉模拟评分(VAS)、Ramsay镇静评分及不良反应。结果A组镇痛效果明显优于B组和C组(P<0.05),B组、C组镇痛效果差异无统计学意义(P>0.05)。C组Ramsay镇静评分明显大于A组、B组(P<0.05)。三组患者均无明显的呼吸抑制,B组有3例发生瘙痒,C组53%的患者出现多汗;三组患者恶心的发生率分别为5.6%、51.0%和54.3%,呕吐的发生率分别为9.0%、54.6%、57.6%。结论罗哌卡因复合哌替啶用于术后PCEA的效果优于罗哌卡因复合吗啡或曲马多,而且不良反应少,是一种能获得平衡镇痛的较好方法。Objective To compare the analgesic effects and adverse effects of ropivacaine combined with pethidine, morphine or tramadol for postoperative patient control epidural analgesia（PCEA）. Methods 90 ASA I-Ⅲ patients scheduled for elective abdominal or legs surgeries were randomly divided into 3 groups. Group A （30 cases） ：ropivacaine 200 mg ＋ pethidine 50 mg ＋ ondansetron 4mg;Group B（30 cases） ：ropivacaine 200 mg ＋ morphine 5 mg ＋ ondansetron 4 mg;Group C（cases） ：ropivacaine 200mg ＋ tramadol 600 mg ＋ ondansetron 4 mg. The VAS, Ramsay sedation scores,HR,BP,SpO2 and adverse effects were observed at 4 th,8 th,24 th,48 th hour after operation. Results VAS in group A was lower than those in group B and group C （ P 〈 0.05） , and there was no significant difference in VAS between group B and group C（ P 〉 0.05）. Ramsay sedation scores of group C were higher than those of group A and group B （ P 〈 0.05）. There was no respiratory arrest in 3 groups. Incidences of nausea, vomiting in group A were lower than those in group B and C. Conclusion Ropivacaine combined with pethidine for postoperative PCEA has a better analgesic effect than ropivacaine combined with morphine or tramadol.

关 键 词：硬膜外镇痛 罗哌卡因 哌替啶 吗啡 曲马多 

分 类 号：R614[医药卫生—麻醉学]