摘要
目的:观察硬膜外注射曲马多和咪唑安定对下肢骨关节疾病术后的镇痛效果,以及对血流动力学与呼吸情况变化的影响。方法:随机选择2004-04/2005-04解放军第四军医大学唐都医院骨科的60例连续硬膜外麻醉下行下肢骨关节疾病手术的患者,经解放军第四军医大学唐都医院伦理委员会批准,患者均签署知情同意书。随机分为曲马多联合咪唑安定组、单纯曲马多组,各30例。两组患者均在连续硬膜外阻滞下实施手术,关腹时,曲马多联合咪唑安定组将曲马多100mg和咪唑安定2.5mg用生理盐水稀释至10mL,单纯曲马多组将曲马多100mg用生理盐水稀释至10mL,均一次性缓慢注入硬膜外腔。监测注药前、注药后10,20,30min的平均动脉压、心率、血氧饱和度、呼吸频率及心电图变化。PrinceHennry疼痛评分标准评价镇痛效果,同时记录镇痛时间及不良反应。结果:按意向处理分析,实验纳入患者60例均进入结果分析。①曲马多联合咪唑安定组疼痛评分为(1.25±1.10)分,疼痛完全缓解率为87%;单纯曲马多组疼痛评分为(1.75±1.12)分,疼痛完全缓解率为73%,两组比较差异无显著性意义(P>005)。曲马多联合咪唑安定组镇痛时间明显长于单纯曲马多组[(15.4±4.4),(10.9±0.9)h,P<0.01]。②两组用药前、注药后10,20,30min平均动脉压、心率、呼吸频率和血氧饱和度变化均无明显差异(P>0.05)。结论:术后硬膜外注入曲马多和咪唑安定可提供确切的镇痛效果,且患者呼吸及循环功能稳定,是一种安全可靠的术后镇痛方法。
AIM： To observe the analgesia effect and adverse reaction of epidural tramadol and midazola injection, and the influence on hemodynamic and respiration in patients after osteoarthropathy operation.
METHODS： Sixty patients, who underwent osteoarthropathy in the Department of Orthopaedics, Tangdu Hospital of the Fourth Military Medical University of Chinese PLA between April 2004 and April 2005, were randomly divided into 2 groups： group Ⅰ （tramadol and midazolam group, n=30） and group Ⅱ （tramadol group, n=30）. When closing the abdominal cavity, 10 mL analgesic solution in both groups was slowly injected to epidural space. In group Ⅰ, 100 mg tramadol and 2.5 mg midazolam were diluted with normal saline, while in group Ⅱ 100 mg tramadol diluted. The mean arterial pressure, heart rate, blood oxygen saturation, respiratory frequency and changes of electrocardiogram （ECG） were monitored before injection and at 10, 20 and 30 minutes after injection. The analgesic effect was assessed with Prince Hennry scale. The ar, algesic time and adverse reactions were also recorded.
RESULTS： According to intention-to-treat analysis, all the 60 cases were involved in the analysis of results. ① In group Ⅰ, the analgesic score was （1.25±1.10） points, and the remission rate of pain was 87%, which were insignificantly different from those in group Ⅱ [（1.75±1.12） points, 73%, P 〉 0.05]. The analgesic time was markedly longer in group Ⅰ than in group Ⅱ [（15.4±4.4）, （10.9±0.9） hours, P 〈 0.01]. ② There were no obvious dif- ferences in the changes of mean arterial pressure, heart rate, blood oxygen saturation, respiratory frequency before injection and at 10, 20 and 30 minutes after injection in both groups （P 〉 0.05）.
CONCLUSION： The postoperative analgesic effect of epidural injection of tramadol and midazola is definite, and the respiratory and circulative functions of the patients are stable, so it is a safe and effective method for postoperative pain.
出处
《中国临床康复》
CSCD
北大核心
2005年第46期108-109,共2页
Chinese Journal of Clinical Rehabilitation
