不同药物配方用于老年患者术后硬膜外镇痛

目的比较吗啡、曲马多及喷他佐辛配伍0.15%罗哌卡因用于老年患者髋关节手术后硬膜外镇痛的临床效果及不良反应。方法选择65～85岁择期髋关节手术患者90例(ASAI～III级),随机分为3组,每组30例,镇痛配方:M组吗啡5mg,T组曲马多500mg,P组喷他佐辛90mg,各组均加罗哌卡因150mg,并加生理盐水配至100ml,各组负荷剂量均为3ml,背景剂量1.5ml,每次按压为2ml,锁定时间为10min。观察并记录术后1、4、8、12、24、48小时患者的疼痛评分(VAS)、RameSay镇静评分、患者对PCA综合满意度及恶心呕吐、皮肤瘙痒等不良反应情况。结果除1h外,T组各时间点VAS评分均高于M组及P组(P<0.05);在镇静与不良反应方面:P组恶心呕吐发生率明显低于T组(P<0.01)及M组(P<0.05);M组有3例(10.0%)出现过度镇静,4例(13.3%)出现皮肤瘙痒,1例(3.3%)呼吸抑制(SPO2<90%),其余两组无患者出现过度镇静、皮肤瘙痒及呼吸抑制。结论吗啡、曲马多及喷他佐辛配伍0.15%罗哌卡因用于老年患者髋关节手术后硬膜外镇痛均能取得较好的镇痛效果,而喷他佐辛PCEA恶心呕吐、皮肤瘙痒及呼吸抑制等不良反应的发生率明显低于吗啡和曲马多。

Application of Postoperative Epidural Analgesia with Different Composition in Elderly Patients

Objective To compare the clinical effects and adverse effects of patient-controlled epidurl analgesia (PCEA) with morphine,tramadol and pentazoxine combined with 0.15% ropivacaine after hip joint operation in elderly patients. Methods Ninety ASA I ～ III elder patients,aged 65 ～ 85 years old,scheduled for hip joint operation were randomly divided into three groups (n=30) according to the content of composition. Group M:0.005% Murphine + 0.15% Ropivacaine. Group T:0.5% Tramadol + 0.15% Ropivacaine. Group P:0.09% pentazoxine + 0.15% Ropivacaine. The visual analog scales (VAS) and sedation scales (SS) were recorded at 1,4,8,12,24 and 48 h after operation.The adverse effects were observed as well. Results The VAS scores were lower in group M and group P than those in group T at all time points except 1 h after operation(P <0.05),The rates of postoperation nausea and vomiting of group P were significantly lower than that of group T(P <0.01)and group M(P <0.05),there were 3 cases (10.0%) oversedative,4 cases (13.3%) pruritus and 1 case (3.3%) respiratory depression occurred in group M,but there were no case of oversedative,pruritus and respiratory depression occurred in group P and group T. Conclusion Morphine,tramadol and pentazoxine combined with 0.15% ropivacaine for epidural analgesia after hip joint operation in elderly patients can provide effective analgesia,but the adverse effects of pentazoxine are significantly lower than morphine and tramadol.