舒芬太尼复合曲马多用于老年髋部手术患者术后静脉自控镇痛的研究  

Comparison of Patient-Controlled Intravenous Analgesia with Sufentanil and Sufentanil Combined with Tramadol for Elderly Patients Undergoing Hip Operation

作　　者：曾鸿[1] 蒋建渝[1] 杨晓霞[1] 

机构地区：[1]北京大学第三医院麻醉科,北京100191

出　　处：《中国微创外科杂志》2009年第11期1025-1028,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨舒芬太尼复合曲马多用于老年髋部手术后患者自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)的效果与不良反应。方法40例择期在腰麻联合硬膜外麻醉下行髋部手术的老年患者,按随机数字表随机分为单纯舒芬太尼组(S组)和舒芬太尼复合曲马多组(T组),每组各20例。术毕缓慢经静脉注射欧贝8mg,连接电子镇痛泵。镇痛药物:S组为舒芬太尼100μg+0.9%NaCl100ml,T组为舒芬太尼50μg+曲马多400mg+0.9%NaCl100ml,负荷剂量1ml,持续输注速率1.5ml/h,病人自控镇痛(patient-controlled analgesia,PCA)剂量0.5ml,锁定时间15min。分别于术后4、20、24、48h随访病人并记录静息时和运动时的视觉模拟评分(visual analogue score,VAS),各时点的呼吸频率(respiration rate,RR),心率(heart rate,HR),平均动脉压(mean arterial pressure,MAP),脉搏血氧饱和度(peripheral oxygen saturation,SPO2),镇静评分(sedation scale,SS),记录使用镇痛泵48h内恶心呕吐的发生率。结果术后48h内,2组患者静态和动态VAS评分的差异均无统计学意义(P>0.05),除术后4h2组患者的动态VAS评分>3以外,其余各时点2组患者静态和动态VAS均小于3。2组患者HR、SPO2和MAP在各时点组内的差异均无统计学意义(P>0.05)。术后4、20h,S组患者的RR较T组明显降低(P<0.01)。术后4、20h,S组SS评分显著高于T组(P<0.01)。2组恶心、呕吐发生率的差异无统计学意义(10%vs30%,P=0.235;5%vs25%,P=0.182)。结论舒芬太尼复合曲马多可以有效用于老年髋部手术后PCIA,与单用舒芬太尼相比,镇痛效果确切,不良反应减少。Objective To compare the efficacy and adverse effect of sufentanil and sufentanil combined with tramadol for patient-controlled intravenous analgesia （PCIA） immediately after hip operation in elderly patients. Methods Totally 40 elderly patients undergoing selective hip operation were randomly assigned to received sufentanil （S group） or sufentanil plus tramadol （T group, 20 patients in each）. After the operation, ondansetron hydrochloride was injected immediately, and PCIA pump was employed. In S group, sufentanil 100μg ＋ 0.9% NaCl 100 ml was given, while in the T group, sufentanil 50μg ＋ tramadol 400 mg ＋ 0.9% NaCl 100 ml was used. In both the groups, the loading dose was set at 1 ml, speed of infusion was kept at 1.5 ml/h, patient- controlled analgesia （PCA） dose was 0.5 ml, and infusion time was locked at 15 min. At 4, 20, 24, and 48 h, the visual analogue score （VAS）, respiration rate （RR）, heart rate （HR）, mean arterial pressure （MAP）, peripheral oxygen saturation （SPO2 ） and sedation scale （SS） of the patients in each group was measured respectively with the patients at resting status. The rate of nausea and vomiting in 48 h was determined as well. Results No significantly differences was noticed in VAS at both resting and moving status between the two groups （P 〉 0.05 ）. In both the groups, the VASs determined at all the time points with the patients at both resting and moving status were lower than 3, expect for that measured at 4 h with the patients at moving status （ slightly higher than 3）. No significant difference was detected in HR, SPO2 and MAP at all the time points between the two groups （P 〉 0.05）. At 4 and 20 h, the RR in the S group was significantly lower than that in the T group （P 〈 0.01 ）, whereas, the SS in the S group was significantly higher than that in the T group （P 〈 0.01 ）. No significant difference exists in the rate of nausea and vomiting between the two groups （10% vs 30% , P =0. 235; 5% vs 25% , P =0

关 键 词：舒芬太尼 曲马多 患者自控静脉镇痛 

分 类 号：R614[医药卫生—麻醉学]