术后病人应用曲马多复合氟哌啶自控镇痛的临床研究

目的　比较术后病人自控镇痛 (PCA)曲马多与曲马多加氟哌啶的镇痛效果和副作用。方法　对 6 0例选择性全子宫切除病人进行随机、双盲研究 ,将其分成 2组 :单纯曲马多组 (1组 )30例 ,PCA单次给药量曲马多 2 0mg ;曲马多 +氟哌啶组 (2组 ) 30例 ,PCA单次给药量曲马多2 0mg +氟哌啶 0 .1mg ;锁定时间均为 10min。于术后 4、8、12、2 0、2 8、36h分别观察病人的血压、心率、呼吸频率、疼痛评分 (VAS)、恶心、呕吐、镇静评分、复视、眩晕、口干和出汗等副作用。结果　两组病人的VAS评分相似 ,差异无显著意义 (P >0 .0 5 ) ;2组病人恶心、呕吐的发生率明显低于 1组病人 ,差异有显著意义 (P <0 .0 5 ) ;1组中有 10例 (33% )病人需给予胃复安 ,而 2组无一例病人需要抗呕吐药物治疗 (P <0 .0 1) ;两组之间镇静等副作用、按压次数、镇痛药物用量以及生命体征差异无显著意义 (P >0 .0 5 )。结论　术后PCA采用曲马多复合氟哌啶可提供与单纯曲马多同样的镇痛效果 ,但恶心、呕吐明显降低 ,并且不增加镇静。因此 ,开腹全子宫切除病人术后PCA采用曲马多复合氟哌啶效果优于单纯曲马多。

Patient-controlled analgesia with tramadol and tramadol/droperidol mixture after abdominal hysterectomy: a double-blinded, randomized controlled trial

OBJECTIVE: To compare the clinical efficacy and side effects of tramadol and the mixture of tramadol and droperidol for postoperative patient-controlled analgesia (PCA). METHODS: Sixty female patients, aged 18 - 65, scheduled for elective abdominal total hysterectomy with inhalational general anesthesia (induced with fentanyl and propofol, maintained with O(2)-N(2)O and enflurane or isoflurane supplemented by intermittent iv fentanyl and vercuronium for muscle relaxation) were allocated into 2 groups of 30 patients in a random and double blind manner: group 1 (20 mg tramadol) and group 2 (20 mg tramadol plus 0.1 mg droperidol), both with a lockout time of 10 minutes. The VAS, analgesic doses, and side effects were observed 4, 8, 12, 20, 28, and 36 hours after operation respectively. RESULTS: Adequate analgesia was achieved with tramadol or the mixture of tramadol and droperidol. The nausea rates and vomiting rates at any time point in the group 2 were all significantly lower than those in the group 1 (all P < 0.05). Ten patients in the group 1 needed treatment of metoclopramide, and none of patients in the group 2 needed antiemetic (P < 0.01). No significant differences were observed in VAS, sedation score or vital signs (all P > 0.05). CONCLUSION: Providing a similar quality of analgesia with less nausea and vomiting as well as little need for sedative, the combination of tramadol and droperidol is superior to tramadol alone for post-operative PCA.