不同剂量曲马多联合舒芬太尼用于剖宫产术后镇痛的效果比较

摘要

Objective To compare the postoperative analgesic safety, validity and adverse reactions of different doses of tramadol com-bined with sufentanil for cesarean section patients. Methods 240 cesarean section patients with ASA Ⅰ or Ⅱ grade were selected and randomly divided into 3 groups, 80 cases in each group. Group A received sufentanil 50 μg PCIA, group B received tramadol 500 mg ﹢sufentanil 50 μg PCIA, group C received tramadol 800 mg ﹢ sufentanil 50 μg PCIA. All groups were given combined spinal and epidu-ral anesthesia(CSEA), and were connected to the PCIA pump to record the VAS scores, the dosage of analgesic, the valid press number of PCIA, self - reported analgesic effect scores, vital signs and adverse reactions in postoperative 6, 12, 24, 48 h. Results The VAS scores of group B and group C were significantly lower than group A at each postoperative time point( P ﹤ 0. 05); the valid press number of PCIA in group B and group C were significantly lower than that of group A( P ﹤ 0. 05), the self - reported analgesic effect score in group B and group C were significantly higher than that of group A( P ﹤ 0. 05 ); there were no significance differences in NBNA scores of each time point after neonatal nursing among groups; the incidence rate of nausea and vomiting of group C was signifi-cantly higher than that of group A and group B( P ﹤ 0. 05) . Conclusion Tramadol combined with sufentanil in postoperative vein analgesic for cesarean section patients is a convenient and effective measure to reduce the complications and adverse drug reactions;there are no restrictions for the movement of the patients, and has higher satisfaction of over 90% . It has no effect on neonatal neu-robehavioral after lactation and the satisfaction rate is higher.%目的：比较不同剂量曲马多联合舒芬太尼用于剖宫产术后镇痛的安全性及有效性。方法择期剖宫产手术美国麻醉医师协会（ASA）Ⅰ~Ⅱ级患者240例，随机分为3组，各80例。A 组予舒芬太尼50μg 静脉自控镇痛（PCIA），B 组予曲马多500 mg ﹢舒芬太尼50μg PCIA，C 组予曲马多800 mg ﹢舒芬太尼50μg PCIA，3组患者均采用腰硬联合麻醉，手术结束前连接 PCIA 泵，分别于术后6，12，24，48 h记录患者 VAS 评分、镇痛药用量、PCIA 按压次数、自评镇痛效果评分和生命体征及不良反应发生情况。结果术后镇痛各时间点，B 组和 C 组患者 VAS 评分均显著低于 A 组( P ﹤0.05)；B 组和 C 组 PCIA 按压次数显著低于 A 组，有显著统计学差异（ P ﹤0.05）；产妇自评镇痛评分 B 组和 C 组明显高于 A 组，有显著统计学差异( P ﹤0.05)；3组新生儿哺乳后各时点的新生儿神经行为(NBNA)评分都在正常范围内，无统计学差异( P ﹥0.05)；C 组恶心和呕吐发生率均显著高于 A 组和 B 组，差异有统计学意义（ P ﹤0.05）。结论曲马多联合舒芬太尼静脉镇痛用于剖宫产术后使用方便，优势互补，可减少并发症和药品不良反应发生率，且产妇的活动不受限制，镇痛效果优良率为90%，满意度更高，同时对哺乳新生儿神经行为无影响。