乳腺癌根治术后芬太尼、曲马多与吗啡病人自控镇痛的比较

doi:10.3971/j.issn.1000-8578.2386

乳腺癌根治术后芬太尼、曲马多与吗啡病人自控镇痛的比较

Cl inical Study of Patient Controlled Analgesia with Intravenous Fentanyl and Tramadol and Epidural Morphine af ter Radical Mastectomy of Breast Cancer

摘要

摘要: 目的观察比较乳腺癌根治术后芬太尼、曲马多病人自控静脉镇痛（PCIA）与吗啡病人自控硬膜外镇痛（PCEA）临床镇痛效果与副作用。方法选择乳腺癌根治病人180例。A8A（美国麻醉医师协会）分级Ⅰ～Ⅳ级，年龄28～70岁，随机分三组：F（芬太尼）组60例，芬太尼1．0mg＋咪达唑仑10mg＋阿扎司琼10mg＋0．9％生理盐水至100mlPCIA；T（曲马多）组60例，曲马多1000mg＋氟哌利多5mg＋0．9％生理盐水至100ITIlPCIA；M（吗啡）组60例，吗啡5mg＋氟哌利多5mg＋布比卡因150mg＋0．9％生理盐水至100ITIlPCEA。采用韩国奥美泵AUTOMEN2300，设定持续输注2ml／h，单次PCA剂量0．5ml，锁定时间15min。术后48小时观察病人药物用量、镇静评分（SS）镇痛评分（VAS），满意水平及副作用。结果F组48小时芬太尼用量（1．0±0）mg，按键次数（8±1．5）次，T组48小时曲马多用量（908．2±59．7）mg，按键次数（6．5±1．5）次；M组48小时吗啡用量（5．0±0）mg，按键次数0次。镇痛效果：VAS及SS评分无显著性差异，优良率〉97％。满意度无显著性差异。副作用：F组与T组病人恶心、呕吐发生率明显低于M组（P〈0．05），M组皮肤瘙瘁发生率25％，恶心，呕吐发生率28％。呼吸循环变化三组无明显差异（P〉0．05）。结论芬太尼、曲马多PCIA与吗啡PCEA镇痛效果确切，但在副反应方面芬太尼、曲马多PCIA相对较少。

Abstract: Objective 　To compare the pain relief efficacy and complication of Fentanyl and Tramadol int ra2 venous PCA( PCIA) with morphine epidural PCA ( PCEA) . Methods 　One hundred and eighteen Ameri2 can Society of Ananesthetist SA Ⅰ～ Ⅳpatient s ages 35～70 years scheduled for radical mastectomy were divided randomlyinto three groups : Group F ( n = 60) PCIA2Fentanyl 1. 0 mg + Midazolam 10 mg + azas2 t ron 10 mg + 0. 9 % N. S to 100 ml ; Group T ( n = 60) PCIA2Tramadol 1000 mg + Droperidol 5 mg +0. 9 % N. S to 100 ml ; Group M ( n = 60) PCEA2Morphine 1 mg + Droperidol 5 mg + Bupivacaine 150 mg + 0. 9 % N. S to 100 ml. PCA (Automen 2300 bung of Korea) was commenced to the end of agery and continucd for 48 h, PCA settings was : bolus dose of 0. 5 ml, background infusion of 2 ml/ h, lockout time of 15 min. The following parameters were recorded : dosage of drugs, VAS, SS, patient' s satisfactions and complications. Results 　Fentanyl (1. 0 ±0) mg, press key (8 ±1. 5) ; Tramadol (908. 2 ±59. 7) mg, press key (6. 0 ±1. 5) ; morphine (5. 0 ±0) mg, press key 0. There was no significant difference between PCIA and PCEA in VAS, SS and patient satisfaction rate ( > 97 %) . The rate of nausea and vomiting in group F and T was significantly lower than that of group M ( P < 0. 05), group M tickle 25 %, nausea and vomiting 28 %. There was no significant difference among three groups in respiratory and circulation ( P > 0. 05) . Conclusion 　PCIA with fentanyl and t ramadol is better than PCEA with morphine, which might be lower in the rate of complications .

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