硬膜外吗啡单次注射与曲马多自控静注平衡镇痛的有效性和安全性研究  

Study of analgesic efficacy and safety of single-dose epidural Morphine and patient-controlled intravenous analgesia with Tramadol

作　　者：简志刚[1] 李瑞钰[1] 

机构地区：[1]广东省中山市小榄人民医院,广东中山528415

出　　处：《中国医药导报》2010年第27期67-68,70,共3页China Medical Herald

摘　　要：目的:观察硬膜外吗啡单次注射与曲马多自控静注平衡镇痛的有效性和安全性。方法:选择椎管内麻醉的术后患者150例,随机分成三组,M组(n=50)手术结束前30min经硬膜外管注入吗啡1.5mg,术毕接PCEA,剂量为吗啡0.12mg,2ml/h,MT组(n=50)手术结束前30min经硬膜外管注入吗啡1.5mg,于手术结束时接PCIA,剂量为曲马多10mg,2ml/h,T组(n=50)硬膜外管不给吗啡,于手术结束前30min静注曲马多1.5mg/kg后接PCIA,剂量为曲马多10mg,2ml/h,观察三组患者的镇痛、镇静效果,镇痛药追加情况,输注管相关情况,不良反应及生命体征的变化。结果:三组患者的镇痛、镇静效果相当,与输注管相关的高危情况以M组为多,不良反应与所用药物的固有特性有关,在观察项目中TM组的不良反应最少,三组患者的生命体征比较无显著性差异。结论:硬膜外吗啡单次注射与曲马多自控静注平衡镇痛可以提供优良的术后镇痛效果,不良反应比单一用药少,同时可以避免留置硬膜外管带来的高危风险。Objective：To study the analgesic efficacy and safety of single-dose epidural Morphine and patient-controlled intravenous analgesia with Tramadol.Methods：150 patients with intravertebral anesthesia were randomly divided into three groups.In Group M（n=50）,1.5 mg of Morphine was administered epidurally 30 minutes before the end of the surgery.When the surgery ended,patient-controlled epidural analgesia（PCEA） was applied with 0.12 mg,2 ml/h of morphine.In Group MT（n=50）,1.5 mg of morphine was administered epidurally 30 minutes before the end of the surgery.When the surgery ended,patient-controlled intravenous analgesia（PCIA） was applied with 10 mg,2 ml/h of tramadol.In Group T（n=50）,no morphine was administered epidurally;instead,1.5 mg of Tramadol was administered intravenously 30 minutes before the end of the surgery.Then,PCIA was applied with 10 mg,2 ml/h of Tramadol.We observed the analgesic efficacy,the supplementation of analgetics,the infusion set,adverse drug reactions and the changes of vital signs.Results：Similar analgesic efficacy was found in the three groups.High risks related to the infusion tube were the most significant in Group M.Adverse drug reactions were related to the inherent characteristics of the drugs used.In Group MT,there were the fewest cases of ADR.There were no significant differences in the vital signs of the three groups.Conclusion：Balanced analgesia of single-dose epidural Morphine and patient-controlled intravenous analgesia with Tramadol could lead to good postoperative analgesia.There are fewer cases of ADR in balanced analgesia than in other kind of analgesia.At the same time,the high risks of indwelling epidural tubes could be avoided.

关 键 词：镇痛 平衡镇痛 曲马多 吗啡 

分 类 号：R614[医药卫生—麻醉学]