曲马多和吗啡用于术后PCIA的观察与比较

目的通过对开胸术后剧痛病人行曲马多病人自控镇痛(patient controlled intravenous analgesia,PCIA)并与吗啡PCIA比较,评定曲马多对病人镇痛程度和恶心、呕吐等不良反应的发生率以及在呼吸系统和心血管系统方面的安全性.方法择期开胸手术病人60例随机分为曲马多组和吗啡组,每组30例,两组病人全麻诱导术中麻醉维持用药相同,术毕清醒拔管后与外周输液静脉连接PCA泵.镇痛治疗时间48h.PCIA选择负荷剂量 维持剂量 PCIA给药模式.术后4,8,12,24和48h随访并记录BP,P,R及药物用量、疼痛评分、恶心呕吐、皮肤骚痒等情况.结果两组镇痛效果无显著性差异;曲马多组不良反应低于吗啡组.结论曲马多用于术后PCIA与传统的吗啡相比:镇痛效果较好,曲马多用于术后PCIA是一种有效、安全的方法.

Comparison of patient controlled intravenous analgesia with tramadol or morphine for postoperative pain relief

Objective: To investigate and compare the clinical effects of patient controlled intravenous analgesia (PCIA) with tramadol or morphine for patients after thoracotomy. The analgesic efficacy, side effects such as nausea and vomiting and safety in cardiorespiratory system were evaluated. Method: 60 patients undergoing thoracotomy were randomly divided into two groups: tramadol and morphine group (n =30). The induction and maintenance of anesthesia were same in two groups. PCIA was started just after the extubation at the end of operation and kept for 48 hours. The model of PCIA was bolus basal dose PCIA. Patients were visited 4, 8, 12, 24, and 48 hours postoperatively and recorded blood pressure, pulse rate, respiratory rate, analgesic dose, pain scores, and side effects such as nausea, vomiting, pruritus, etc. Results: There were no statistical significant differences in pain scores between tramadol and morphine group. The side effects on patients with PCIA tramadol were less than that on patients with PCIA morphine. Conclusion: Tramadol in compared with morphine as intravenous PCA drug for postoperative pain control has good clinical effect. Tramadol PCIA is an effective and safe method to postoperative pain relief.