曲马多联合地塞米松超前镇痛用于下肢手术的临床观察  

Effect and security of pre-emptive analgesia with tramadol combined dexamethasone

作　　者：杨世忠[1] 刘孝国[1] 夏新桂[1] 邱建强[1] 肖志刚[1] 谢国水[1] 

机构地区：[1]武警浙江总队医院麻醉科,浙江嘉兴314000

出　　处：《中国医院药学杂志》2011年第4期308-311,共4页Chinese Journal of Hospital Pharmacy

摘　　要：目的:研究曲马多联合地塞米松超前镇痛应用于下肢手术的镇痛效果及安全性。方法:将75例骨科下肢择期手术患者随机分为3组,A组:曲马多3mg.kg-1+地塞米松10mg;B组:曲马多3mg.kg-1+生理盐水(2mL);C组:单纯生理盐水(6mL)。各组于术前30min静注相应药物,术中患者采用连续硬膜外神经阻滞,术后予静脉自控镇痛(PCIA;2mL.h-1,48h)。记录术后2,4,8,12,24,48h各时点的视觉模拟评分(VAS)与术后48h最痛程度(PD)评分、术后2d平均疼痛程度(MD)评分来评价其镇痛效果,以舒适度分级(BCS)及睡眠障碍度分级(SS)来评价患者对术后镇痛的满意程度,记录术后各组辅助镇痛药物的使用情况,同时观察恶心、呕吐、皮肤瘙痒、嗜睡、切口感染、延迟不愈等相关不良反应。结果:C组术后2,4,8,12,24,48h VAS评分高于A、B组(P<0.05),同时BCS分级低于A、B组(P<0.05);A组术后2,4,8,12h的VAS评分低于B组((P<0.05);术后48h内A组的PDMDSS评分均低于B、C组(P<0.05),A、B组辅助镇痛药物的使用量明显少于C组(P<0.05),恶心呕吐的发生率A组低于B、C组(P<0.05)。结论:曲马多联合地塞米松超前镇痛应用于骨科下肢手术,能有效缓解术后疼痛,提高患者对镇痛的满意度,同时减少术后辅助镇痛药物的使用及相关不良反应。OJECTIVE To observe the effect and security of pr-emptive analgesia with tramadol combined dexamethasone in patients undergoing lower extremity surgery. METHODS Seventy-five patients undergoing lower extremity surgery were randomly divided into three groups. Group A were treated with tramadol 3 mg·kg^-1 ＋ dexamethasone l0 mg, Group B were treated with tramadol 3 mg·kg^-1 ＋ NS 2 mL,Group C were treated with NS 6 mL. The drugs were injected 30 mins before op eration,all patients were received continuous epidural anesthesia and followed by PCIA postoperatively for 48 h （2 mL·h^-1 ）.Recorded the visual analogue scale （VAS） at 2,4,8,12,24,48 h after surgery to assess the analgesia effects,BCS and SS to e valuate the satisfaction of analgesia postoperation, and recorded the consumption of assisted analgesic after surgery in each group,at the same time side effects like nausea,vomit, skin itch, somnolence, infection of incision, slow healing were observed. RESULTS The VAS of patients in group C were significantly higher （P〈0.05） than group A and B at 2,4,8,12,24 h postop eration,and BCS were lower（P〈0. 05） than A and B; The VAS of patients in group A were lower （P〈0. 05） than group B at 2,4,8, 12 h postoperation; PD, MD, SS in group A were lower （P〈0. 05） than group B and C at 24 h postoperation, the con sumption of assisted analgesic in group A and B were significantly lower（P〈0. 05） than C,the incidence of nausea and vomit in group A were lower （P〈0.05） than B and C. CONCLUSION Pre-emptive analgesia with tramadol combined dexamethasone in patients undergoing orthopedic surgery can alleviate postoperative pain effectively, increase satisfaction of patients about anal gesia,and can drop the consumption of analgesic after operation and side effects.

关 键 词：曲马多 超前镇痛 地塞米松 静脉自控镇痛 

分 类 号：R969.3[医药卫生—药理学]