曲马多、吗啡单独及联合应用于腹部肿瘤术后镇痛效果比较

背景与目的：吗啡用于术后镇痛时虽然疗效肯定,但副作用较多。曲马多为一新合成的μ-阿片受体激动剂,其用于硬膜外镇痛时疗效、副作用等报道不多。本研究拟比较曲马多、吗啡及其联合用于膜外术后镇痛时的疗效及副作用。方法：120例腹部肿瘤手术病人随机分为曲马多组（T组,n=40)、吗啡组（M组,n=40)和曲马多、吗啡联合组（T＋M组,n=40)行硬膜外术后48h持续、恒速镇痛。镇痛药配方：T组为曲马多12mg/kg 0.125%布比卡因100ml,M组为吗啡0．12mg/kg 0.125%布比卡因100ml,T＋M组为曲马多6mg/kg 吗啡0．06mg/kg 0.125%布比卡因100ml。分别记录三组病人术后VAS评分、BCS舒适评分、病人满意度评分（GSS评分）及副作用。结果：三组VAS评分无差异（P＞0．05）,VAS＞5分者,T组显著多于M组及T＋M组（P＜0．05）。BCS及GSS评分T＋M组显著优于T组及M组（P＜0．05）。恶心、呕吐发生率T＋M组显著低于M组（P＜0．05）。结论：曲马多术后硬膜外镇痛疗效与吗啡近似,但波动较大,用药剂量应个体化。曲马多、吗啡联合用药可获得满意的镇痛效果,显著减少恶心、呕吐等副作用的发生。

Comparison of postoperative analgesia with tramadol,morphine versus their combination in patients undergoing abdominal cancer surgery

BACKGROUND & OBJECTIVE: Morphine is a widely used analgesic in management of postoperative pain with well documented analgesic properties and side effects. Tramadol, a new synthetic mu-opioid receptor agonist, little is known about its efficacy and side effects when administered in epidural for pain relief. The aim of this study is to compare the efficacy and side effects of tramadol, morphine versus their combination for postoperative analgesia. METHODS: One hundred and twenty patients undergoing abdominal cancer surgery were assigned to one of three groups randomly, tramadol group (Group T, n = 40), morphine group(Group M, n = 40) and combination of tramadol and morphine group(group T + M, n = 40), for postoperative analgesia. In group T, 12 mg/kg tramadol and 0.125% bupivacaine 100 ml were used for 48 h postoperative analgesia. In group M, 0.12 mg/kg morphine and 0.125% bupivacaine 100 ml; and in group T + M, 6 mg/kg tramadol, 0.12 mg/kg morphine and 0.125%. Bupivacaine 100 ml were used for postoperative analgesia. Efficacy was assessed by comparing visual analogue scale(VAS), Bruggman comfort score (BCS), global satisfaction score (GSS) at several time points over 48 hours. Possile adverse events were recorded. RESULTS: There is no significant difference among three groups in VAS, but in group T, there are more patients whose VAS > 5 score than those in group M and group T + M. BCS; GSS in group T + M are lower than that in group T and group M. The occurrence rate of nausea and vomiting in group T + M are lower than that in group M. CONCLUSIONS: The efficacy of tramadol in epidural postoperative analgesia is similar to that of morphine, but varied from patient to patient, so the dose of tramadol should be individualized. Combination of tramadol and morphine can provide effective analgesia for postoperative pain and cause little adverse effect, especially reduce the occurrence rate of nausea and vomiting.