乳腺癌根治术后芬太尼、曲马多与吗啡病人自控镇痛的比较

目的观察比较乳腺癌根治术后芬太尼、曲马多病人自控静脉镇痛（PCIA）与吗啡病人自控硬膜外镇痛（PCEA）临床镇痛效果与副作用。方法选择乳腺癌根治病人180例。A8A（美国麻醉医师协会）分级Ⅰ～Ⅳ级，年龄28～70岁，随机分三组：F（芬太尼）组60例，芬太尼1．0mg＋咪达唑仑10mg＋阿扎司琼10mg＋0．9％生理盐水至100mlPCIA；T（曲马多）组60例，曲马多1000mg＋氟哌利多5mg＋0．9％生理盐水至100ITIlPCIA；M（吗啡）组60例，吗啡5mg＋氟哌利多5mg＋布比卡因150mg＋0．9％生理盐水至100ITIlPCEA。采用韩国奥美泵AUTOMEN2300，设定持续输注2ml／h，单次PCA剂量0．5ml，锁定时间15min。术后48小时观察病人药物用量、镇静评分（SS）镇痛评分（VAS），满意水平及副作用。结果F组48小时芬太尼用量（1．0±0）mg，按键次数（8±1．5）次，T组48小时曲马多用量（908．2±59．7）mg，按键次数（6．5±1．5）次；M组48小时吗啡用量（5．0±0）mg，按键次数0次。镇痛效果：VAS及SS评分无显著性差异，优良率〉97％。满意度无显著性差异。副作用：F组与T组病人恶心、呕吐发生率明显低于M组（P〈0．05），M组皮肤瘙瘁发生率25％，恶心，呕吐发生率28％。呼吸循环变化三组无明显差异（P〉0．05）。结论芬太尼、曲马多PCIA与吗啡PCEA镇痛效果确切，但在副反应方面芬太尼、曲马多PCIA相对较少。

Clinical Study of Patient Controlled Analgesia with Intravenous Fentanyl and Tramadol and Epidural Morphine after Radical Mastectomy of Breast Cancer

Objective 　To compare the pain relief efficacy and complication of Fentanyl and Tramadol int ra2 venous PCA( PCIA) with morphine epidural PCA ( PCEA) . Methods 　One hundred and eighteen Ameri2 can Society of Ananesthetist SA Ⅰ～ Ⅳpatient s ages 35～70 years scheduled for radical mastectomy were divided randomlyinto three groups : Group F ( n = 60) PCIA2Fentanyl 1. 0 mg + Midazolam 10 mg + azas2 t ron 10 mg + 0. 9 % N. S to 100 ml ; Group T ( n = 60) PCIA2Tramadol 1000 mg + Droperidol 5 mg + 0. 9 % N. S to 100 ml ; Group M ( n = 60) PCEA2Morphine 1 mg + Droperidol 5 mg + Bupivacaine 150 mg + 0. 9 % N. S to 100 ml. PCA (Automen 2300 bung of Korea) was commenced to the end of agery and continucd for 48 h ,PCA settings was : bolus dose of 0. 5 ml , background infusion of 2 ml/ h , lockout time of 15 min. The following parameters were recorded : dosage of drugs , VAS , SS , patient’ s satisfactions and complications. Results 　Fentanyl (1. 0 ±0) mg , press key (8 ±1. 5) ; Tramadol (908. 2 ±59. 7) mg , press key (6. 0 ±1. 5) ; morphine (5. 0 ±0) mg , press key 0. There was no significant difference between PCIA and PCEA in VAS , SS and patient satisfaction rate ( > 97 %) . The rate of nausea and vomiting in group F and T was significantly lower than that of group M ( P < 0. 05) , group M tickle 25 % , nausea and vomiting 28 %. There was no significant difference among three groups in respiratory and circulation ( P > 0. 05) . Conclusion 　PCIA with fentanyl and t ramadol is better than PCEA with morphine , which might be lower in the rate of complications .