等效剂量曲马朵、吗啡、芬太尼用于老年人术后硬膜外自控镇痛的临床观察

目的　观察丁哌卡因分别与等效剂量的曲马朵、吗啡、芬太尼配伍用于老年人术后硬膜外镇痛的临床效果和不良反应。方法　老年病人 12 0例 ,ASAⅠ～Ⅱ级 ,随机平均分为三组 :T组 (0 .12 5 %丁哌卡因 10 0ml加曲马朵 10 0mg) ;M组 (0 .12 5 %丁哌卡因 10 0ml加吗啡 10mg) ;F组 (0 .12 5 %丁哌卡因 10 0ml加芬太尼 0 .1mg)。PCEA参数设置为 :负荷剂量5ml、连续输注速率 1.5ml/h、单次PCA剂量 1ml、锁定时间 2 0min ;对术后 2、4、8、12、2 4、48h静息及活动时疼痛的VAS评分 ;监测用药前及用药后 3 0min、用药后 1、2、4、8、12、2 4h的RR、SaO2 、MAP变化及不良反应。结果　三组病人静息时镇痛效果差异无显著性 (P >0 .0 5 )。活动时 ,在时点 8、12时M组病人镇痛效果优于T组和F组 (P <0 .0 5 )。所有病人用药前与用药后RR、SaO2 、MAP均保持正常 ;恶心、呕吐的发生率T组明显高于F组 (P <0 .0 5 ) ,仅M组有 10例发生皮肤瘙痒。结论　等效剂量曲马朵、吗啡、芬太尼分别复合丁哌卡因用于老年人术后硬膜外自控镇痛均可取得良好的临床效果 ,仅在活动时吗啡的镇痛效果优于曲马朵和芬太尼。

Clinical evaluation of eqivalent dose of Tramadol, Morphine, Fentanyl for patient-controlled epidural analgesia after surgery in the elderly patients

Objective To assay the clinical efficacy and side-effects of equivalent dose of Tramadol, Morphine and Fentanyl combined with Bupivacaine for patient-controlled epidural analgesia (PCEA) in the post-operative elderly patients. Methods 120 elderly patients, ASAⅠ～Ⅱ, were randomly divided into three groups: Group T (0.125% Bupivacaine 100ml + Tramadol 100mg), Group M (0.125% Bupivacaine + Morphine 10mg); Group F (0.125% Bupivacaine 100ml + Fentanyl 0.1g). PCEA parameters: loading dose 5ml; continuous injection rate 1.5ml/h; PCA single dose 1ml; lockout time 20 minutes. The VAS at rest and movement were recorded at 2、4、8、12、24、48 hours after administration. RR, SaO 2, MAP changes and side-effects were monitored at 30 minutes before and after administration, and a1so at 1、 2、4、8、12、24 hours after treatment. Results There were no significant differences of the rest pain scores between three groups (P>0.05). The PCA efficacy of Group M was better than that of Groups T and F during movement at 8, 12 hours (P<0.05). RR, SaO 2, MAP remained the same in all patients. The incidence of nausea and vomiting was higher in Group T than that in Group F (P<0.05). Cutaneous pruritus was found only in Group M. Conclusions Equivalent dose of Tramadol, Morphine, Fentanyl combined with Bupivacaine can provide safe and effective analgesia for postoperative elderly patients. Only at movement, the analgesia efficacy of Morphine was better than that of Tramadol and Fentanyl.