【摘要】 目的 :比较等效剂量的吗啡、芬太尼、度冷丁、曲马多在硬膜外术后自控镇痛 (PCEA)的镇痛效果和不良反应。方法 :选择 80例硬膜外麻醉下妇产科手术病人 ,随机分为四组 ,每组 2 0例 :0 .15 %布比卡因 10 0ml分别含吗啡 10mg(BM组 )、芬太尼 0 .1mg (BF)组、度冷下 10 0mg(BD组 )曲马多 10 0mg(BT组 )采用佳士 930 0镇痛泵 ,选择负荷剂量—连续输注—PCA模式 ,其剂量为 5ml— 1ml— 1ml,患者感疼痛时自行按压PCA健。结果 :48h累积镇痛液用量为BF组≈BD组 >BT组 >BM组。BM组镇痛效果达优者比其他各组多。BF组、BD组的D/D值高于BM组。镇痛期间MAP、PR、RR与麻醉前比较无明显差异 ,SpO2 保持在 95 %以上。各组的恶心、呕吐发生率似无明显差异 ,只有BM组出现皮肤搔痒。结论 :用低浓度的布比卡因和镇痛药复合用于PCEA对呼吸、循环功能无明显影响。BM组镇痛效果最好 ,镇痛复合液用量最少。更多还原

【Abstract】 Objective: To compare analgesic effect and side effect among morphore,fentanyl,pethidine,and trmadol at a equivalent dose with 0.15% bupivacaine in postoperative controlled epidural analgesia(PCEA).Methods:Eighty adult female patients undergoing gynaecological or obstetrical operation with epidural anesthesia were treated with PCEA pump postoperatively.All patients were randomly divided into 4 groups accoding to the narcotics( n =20 for each group).The analegsic solution contained morphine 10 mg(group BM),fentanyl 0.1 mg(groupBF),pethidine 100 mg(group BD),or trmadol 100 mg (group BT)each drug in 0.15%bupivacaine 100 ml,respectively.Graseby 9300 PCA pump of loading continuous PCA model with 5ml 1 ml 1 ml was used in all patients.Results: The order of cumulative amount of analgesic solution in four groups was BF≈BD>BT>BM.There were more cases of excellent analgesia in group BM than in the others.Both ratios of deliveries to demands in groups BF and BD were higher than thar in group BM.MAP,pulse rate,and respiratory rate had no significant change in all group.SpO 2 was maintained over 95% in all groups.The incidences of nausea and vomiting in all groups were similar.Only 8 patients in group BM complained skin itching.Conclusion: The compound solution of low concentration of bupivacaine and narcotics used for postoperative analgesia could make a good analgesic effect without significant influence on the cardio respiratory function.It seems that morphine is better than fentanyl,pethidine,or trmado.更多还原