摘要
目的 观察恩丹西酮对乳腺癌根治术后曲马多病人自控静脉镇痛(PCIA)疗效的影响。方法 40例ASA Ⅰ～Ⅱ级女性乳腺癌病人,随机分为两组:对照组(不用恩丹西酮)和试验组(用恩丹西酮),每组20例。静吸复合全麻下实施乳腺癌根治术,术毕给负荷量后接PCIA泵。术后4、8、12和24 h进行随访,记录曲马多用量、疼痛评分、镇静评分及恶心呕吐发生情况。结果 术后24 h两组患者心率(HR)、血压(BP)平稳,未见呼吸抑制病例,脉搏氧饱和度(SpO2)均维持在95％以上。试验组曲马多用量在4、8、12 h明显高于对照组(P<0.05)。两组疼痛评分各时点均小于4分,且两组间差异无显著性(P>0.05)。两组均未用其它镇痛药。试验组恶心发生率明显高于对照组(P<0.05)。两组呕吐发生率及镇静评分差异无显著性(P>0.05)。结论 曲马多用于乳腺癌根治术后病人自控静脉镇痛效果满意,预防应用恩丹西酮并不能有效地减轻曲马多引起的恶心呕吐,反而减弱其镇痛作用。
Objective To investigate the effect of ondansetron on the analgesic efficacy of tramadol for postoperative patient-controlled intravenous analgesia (PCIA). Methods Forty ASA I - II patients aged 22-74 years, weighing 40-90 kg scheduled for radical mastectomy were randomly allocated to one of two groups : control group ( n = 20) and ondansetron group ( n = 20) . The patients were premedicated with intramuscular atropine 0.01 mg·kg-1 and diazepam 0.2 mg·kg-1. Anesthesia was induced with midazolam 0.1-0.2 mg (total dose was limited to 15 mg), fentanyl 2.4μg·kg-1 , propofol 1.5-2.0 mg·kg-1 and vecuronium 0.12-0.15 mg·kg-1 . The patients were mechanically ventilated after tracheal intubation (VT 8-10 ml·kg-1 , RR 13 bpm). Anesthesia was maintained with enflurane inhalation and continuous infusion of vecuronium. The patients were attached to a PCIA pump after operation and received PCIA with 1 % tramadol (background infusion 2 ml·h-1 , bolus dose 2 ml, lockout interval 10min) in both groups. In ondansetron group the patients received ondansetron 6 mg iv during operation and a loading dose of tramadol 1 mg·kg-1 and ondansetron 2 mg after operation before PCIA. Pain score (VAS 0-10), sedation score (0-3), tramadol consumption and the incidence of nausea and vomiting were recorded at 4, 8, 12 and 24 h after operation. Results There was no significant difference in pain and sedation scores and the incidence of vomiting between the two groups. Significantly more tramadol was consumed at 4, 8 and 12 h after operation in the ondansetron group as compared with control group (P < 0.05). Pain scores were less than 4 and no other analgesic was used in both groups. The incidence of nausea was higher in ondansetron group than that in control group ( P < 0. 05 ) . Conclusion Tramadol offers satisfactory analgesia for patients after radical mastectomy. Ondansetron does not reduce the incidence of nausea and vomiting induced by tramadol but decreases the analgesic efficacy of tramadol instead.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2003年第12期895-897,共3页
Chinese Journal of Anesthesiology
关键词
恩丹西酮
乳腺癌
根治术
曲马多
自控静脉镇痛
Ondansetron
Tramadol
Mastectomy, radical
Analgesia, patient-controlled
Infusions, intravenous
