曲马多联合氟比洛芬酯用于剖宫产术后镇痛及防治寒战的疗效观察

摘要]目的比较剖宫产术后患者自控静脉镇痛（patientcontrolledintravenousanalgesia。PCIA）中曲马多与芬太尼分别联合氟比洛芬酯的镇痛及防治寒战的效果。方法选择剖宫产术后行PCIA患者60例，随机均分为两组，每组各30例。氟曲组关腹前给予氟比洛芬酯50mg，术后镇痛给予曲马多400mg、氟比洛芬酯150mg和托烷司琼5mg溶于生理盐水100ml中。氟芬组关腹前给予氟比洛芬酯50mg，术后镇痛给予芬太尼0．3mg、氟比洛芬酯150mg和托烷司琼5mg溶于生理盐水100ml中。两组PCIA泵的设置：维持量2ml／h，单次负荷剂量0．5ml，锁定时间15min。观察两组术毕给药后12、24、48h的视觉模拟评分（visualanaloguescale，VAS）和寒战发生率。结果两组术后12、24、48h的VAS评分差异无显著意义（P〉0．05）。氟曲组寒战发生率为3．33％（1／30），低于氟芬组的26．67％（8／30），差异显著（P〈0．05）。结论曲马多联合氟比洛芬酯用于剖宫产术后PCIA的镇痛效果确切，与芬太尼联合氟比洛芬酯相似，且寒战发生率降低，值得在临床推广应用。

Tramadol Combined with Flurbiprofen Axetil for Observation of the Curative Effect of the Analgesia and the Prevention of Shivering after Cesarean Section

Objective To compare the effect of analgesia and prevention of shivering after Cesarean sec- tion by patient controlled intravenous analgesia （PCIA） with tramadol combined with flurbiprofen axetil and fen- tanyl combined with flurbiprofen axetil. Methods After Cesarean section, 60 cases of PCIA were randomly divided into two groups for 30 cases each. In group A, the patients were given flurbiprofen 50 mg after abdomi- nal closure, and the postoperative analgesia recipe was tramadol 400mg ＋ flurbiprofen 150 mg ＋ tropisetron 5mg dissolved in 100ml normal saline. In group B, the patients were also given flurbiprofen 50 mg after abdom- inal closure, and the postoperative analgesia recipe was fentanyl O. 3 mg ＋ flurbiprofen 150 mg ＋ tropisetron 5mg dissolved in 100ml normal saline. Two groups of PCIA pump settings of the two groups were as follows ： mainte- nance dose of 2 ml/hour, the single loading dose of 0.5 ml and the locking time was 15 minutes. Visual ana- logue score （VAS） in each group was observed 12, 24 and 48 hours after administration, and the shivering in- cidence was also recorded. Results There was no significant difference between the two groups of postopera- tive VAS scores 12, 24 and 48 hours after operation （ P 〉 O. 05 ）. The shivering incidence as 3.33 % （ 1/30 ） in group A, which was low than 26.67 % （8/30） in group B （P 〈 0.05 ）. Conclusion It is effective of the PCIA by tramadol and flurbiprofen axetil after cesarean section, which is similar to fentanyl and flurbiprofen ax- etil, and can reduce the incidence of shivering. It is worth promoting of the tramadol combined wtih flurbiprofen axetil for the PCIA after cesarean section.