芬太尼与曲马多加强腹部肿瘤患者术后镇痛的对比研究  

Contrastive Study of Strengthening Effect on Abdominal Tumor Surgery between Fentanyl and Tramadol

作　　者：江伟哲[1] 陈一丁[1] 杜艺[1] 

机构地区：[1]四川省肿瘤医院麻醉科,成都610041

出　　处：《肿瘤预防与治疗》2011年第5期240-242,共3页Journal of Cancer Control And Treatment

摘　　要：目的:评价枸橼酸芬太尼和盐酸曲马多对腹部肿瘤患者术后镇痛的强化作用。方法:36例腹部肿瘤开腹手术患者,随机分为3组(A、B、C),每组12例。A组,枸橼酸芬太尼2μg/kg+昂丹司琼4mg静脉注射;B组,盐酸曲马多2mg/kg+昂丹司琼4mg,静脉注射;C组,生理盐水2ml+昂丹司琼4mg,静脉注射。观察术后镇痛效果,及对呼吸循环的影响,以及对术后使用枸橼酸舒芬太尼自控镇痛(Patient Controlled Analgesia,PAC)患者的接压次数和药物用量。结果:A组和B组术毕视觉模拟评分(Visual Amalogne Score,VAS)差异无统计学意义(P>0.05),C组术毕VAS评分明显高于A、B组,分别相比差异均有统计学意义(P<0.001)。A、B、C 三组术后24hVAS评分差异均无统计学意义(P>0.05)。各组心率,平均动脉压术前与术毕相比无显著差异(P>0.05),各组间嗜睡,躁动,寒战,恶心呕吐发生率均无明显差异(P>0.05),呼吸恢复时间B、C组低于A组(P<0.05),呼末二氧化碳分压C、B组低于A组(P<0.01)。术后PCA次数和镇痛药物用量A、B组小于C组(P<0.05)。结论:曲马多和芬太尼对加强术后镇痛效果相当,但芬太尼的呼吸抑制作用大于曲马多。Objective： To evaluate the strengthening effect accepted fentanyl and tramadol on patients accepted abdominal tumor surgery for postoperative analgesia. Methods： 36 patients undergoing abdominal surgery were randomly divided into 3 groups （A,B and C） with 12 patients in each group. A group with fentanyl 21xg/kg ＋ ondansetron 4mg, B group with tramadol 2mg/kg ＋ ondansetron 4mg, and C group using normal saline 2ml ＋ ondansetron 4mg. The inhibitory effect of postoperative pain, respiratory and circulatory side effects, and postoperative PCA sufentanil citrate saving were observed. Results： The VAS scores which A group and B group patients completed showed no significant difference（ P 〉 0.05 ）. The VAS score of C group patients was significantly higher than that of A and B group, with significant differences respectively （P 〈0. 001 ）. After 24h, VAS scores of A, B and C Group had no sig- nificant difference （P 〉 O. 05 ）. As regards the HR and MAP, there were no significant differences before and after operation （ P 〉 0. 05）. Among the 3 groups, lethargy, irritability, chills, nausea and vomiting showed no significant difference （P 〉 0.05 ）. The breathing recovery time of C and B group was shorter than that of A group （P 〈 0. 05）. The PaCO2 of C and B group were lower than that of A group（P 〈0. 01 ）. The times of postoperative PCA and the quantity of analgesics of A and B group were less than that of C group （P 〈0.05）. Conclusion： Tramadol and fentanyl have the same effect on strengthening the postoperative analgesia. However, the respiratory depression by fentanyl has a stronger inhibiting effect than that by tramadol.

关 键 词：术后镇痛 腹部肿瘤手术 曲马多 芬太尼 

分 类 号：R730.5[医药卫生—肿瘤]