曲马多用于经腹全子宫切除术后静脉自控镇痛的临床效果评价

目的　比较曲马多与传统阿片类药物吗啡对经腹全子宫切除术患者的镇痛效果及不良反应。方法　对 80例ASAⅠ～Ⅱ级的经腹全子宫切除术患者进行随机、双盲研究。分为 4组 :曲马多组 (T组 ,n =2 0 ) ,吗啡组 (M组 ,n =2 0 ) ,吗啡 +氟哌利多组 (M +D组 ,n=2 0 ) ,曲马多 +氟哌利多组 (T +D组 ,n =2 0 ) ,分别于术后 4、8、12、16、2 0、2 4h观察BP、HR、疼痛评分VAS(视觉模拟评分法 )、PrineHenry评分 (PHS)、镇静评分 (SS)、恶心、呕吐、眩晕、口干、瘙痒、尿潴留等不良反应 ,并记录 2 4h的用药量。结果　VAS、PHS 4组患者无显著性差异 ;镇静评分 (SS)M +D组在 4、8、12h高于其他 3组且有显著性差异 ;恶心呕吐发生率 :T组与M组 >M +D组 >T +D组 ,T组与M组间无显著性差异 ;瘙痒及尿潴留的发生率M及M +D组高于其他两组。结论　曲马多用于经腹全子宫切除术的患者能够获得与吗啡相同的镇痛效果且瘙痒及尿潴留的发生率低 ,虽恶心呕吐的发生率较高 ,联合应用氟哌利多后‘可明显降低。

Evaluation of tramadol for patient-controlled intravenious analgesia after abdominal total hysterectomy

Objective To compare the effects and side effects of tramadol and morphine used for patient-controlled analgesia (PCA) delivery system after abdominal total hysterectomy Methods A single centre, randomized double-blind study of ASAⅠ～Ⅱ 80 patients undergoing elective abdominal total hysterectomy with inhalational anesthesia was performed. The patients were divided into four groups: tramadol group (group T, n=20), morphine+droperidol group (group M+D, n=20), morphine group (group M, n=20), and tramadol +droperidol group (group T+D, n=20). The study lasted for 24 h and the following data were collected: heart rate, blood pressure, respiration, VAS, sedation score (SS), Prince Henry score (PHS) as well as side effects. The consumption of analgesics within 24 hours were also recorded. Results VAS and PHS showed no differences between the four groups. M+D group was higher than the other groups in 4, 8, and 12 h of SS. The rates of postoperative nausea and vomiting (PONV) of group T and group M were higher than those of group M+D (P< 0.05), but group M+D was higher than group T+D, there was no difference between T group and M group; the rates of pruritus and urine retention of group M and group M+D were higher than other groups. Conclusion Tramdol PCIA can provide the same effective analgesia as morphine in patients undergoing abdominal total hysterectomy and the rate of pruritus and urine retention is lower than morphine. Although the incidence of nausea and vomiting is high, combining with droperidol can reduce the incidence.