罗哌卡因复合曲马多与芬太尼应用于子宫全切术后硬膜外镇痛的临床研究

目的比较曲马多、芬太尼分别和罗哌卡因合用对于子宫全切术后硬膜外镇痛的作用,以期为临床安全合理用药提供依据。方法选择ASAⅠ～Ⅱ级经腹子宫全切患者60例,随机分为3组。R组：0.15%罗哌卡因（n=20）;F组：0.15%罗哌卡因＋0.0004%芬太尼（n=20）;T组0.15%罗哌卡因＋0.5%曲马多（n=20）;3组术后均应用首剂镇痛药0.5%罗哌卡因6ml硬膜外注入,连接一次性微量泵进行硬膜外镇痛。监测术后不同时间的VAS疼痛评分、心率、平均动脉压;观察恶心等不良反应和下肢运动阻滞情况以及肛门排气时间;总体满意度评分。结果R组VAS评分明显高于F组以及T组,差异有统计学意义（P〈0.05）;F组和T组VAS评分无明显差异（P〉0.05）;F组恶心、呕吐发生率高于R组和T组（P〈0.05）;心率、平均动脉压各组间以及术前差异无统计学意义（P〉0.05）;F组和T组镇痛总体满意度优良率明显高于R组（P〈0.05）。结论曲马多、芬太尼分别与罗哌卡因合用均可达到有效的术后硬膜外镇痛效果,曲马多与罗哌卡因配伍不良反应发生率较低,是一种更为安全有效的硬膜外术后镇痛方法。

A comparison of epidural ropivacaine infusion combined with fentanyl or tramadol for postoperative analgesia after abdominal hysterectomy

Objective Comparison with the effect of equivalent dose of fentanyl and tramadol in combination with ropivacaine on continuous epidural postoperative analgesia after abdominal hysterectomy is significance for safety and reasonable administration in epidural postoperative analgesia.Methods 60 patients（ASA classⅠ-Ⅱ）,undergoing abdominal hysterectomy were randomly divided into three groups（20 cases in each group）to receive 0.15%ropivacaine alone（Group R）,0.15%ropivacaine plus 0.000 4%fentanyl（Group F）,and 0.15%ropivacaine plus 0.5%tramadol（Group T）.Postoperatively all the three groups were given a initial epidural loading dose of 0.5%ropivacaine 6 ml,then the disposable micro-infusion pump was applied to continuous epidural postoperative analgesia.VAS,HR,MAP were recorded at different time.The incidence of side-effect,motor block,the time for passage of gas by anus and global satisfaction score were assessed.Results The VAS in Group F and Group T were significantly less than that in Group R（P〈0.05）and no significant difference were noted between Group F and Group T（P〉0.05）.The incidence of nausea and vomiting in Group T were significantly lower than that in Group F（P〈0.05）.HR,MAP had no significantly difference at different time points in the three groups.Compared with Group R significantly higher the global satisfaction score in Group F or Group T（P〈0.05）.Conclusion Ropivacaine infusion in combination with fentanyl or tramadol is efficient for epidural postoperative analgesia.Ropivacaine infusion in combination with tramadol is the better choice because of the less side-effects.