摘要
目的 :观察曲马多连续硬膜外镇痛对胆囊切除病人术后胃肠功能恢复及血清胃动素 (MOT)水平的影响。方法 :择期胆囊切除术病人 2 8例 ,麻醉选择连续硬膜外阻滞。将病人随机分为两组 :3药联用组 ,使用曲马多 80 0mg +布吡卡因 15 0mg +氟哌利多 5mg ,总量 10 0ml,泵速 2ml·h-1;2药联用组 ,配方中不含曲马多 ,余同 3药联用组。观察镇痛期不同时点的VAS值、首次排气、排便时间及放免测定相应时点的MOT水平。结果 :3药联用组VAS均值为 (1.16± 1.15 ) ,2药联用组为 (3.32± 1.2 6) ,两组比较具有显著性差异 (P <0 .0 5 )。首次排气、排便时间 3药联用组分别为 (5 6.8± 16.6)h和 (96.5± 19.7)h ,2药联用组则分别为 (38.8± 14.7)h和(75 .6± 18.3)h ,两组比较有显著性差异 (P <0 .0 5 )。 3药联用组MOT水平从镇痛前的 (135 .6±2 2 .8)pmol·L-1降至 (78.3± 18.8)pmol·L-1(P <0 .0 5 ) ,而 2药联用组镇痛前后变化不明显 ;镇痛后两组间MOT比较 ,P <0 .0 5。排气、排便时间与MOT水平呈显著性负相关 (r =- 0 .4 7,P <0 .0 5 )。此外 ,3药联用组恶心、呕吐和嗜睡的发生率亦高于2药联用组 (P <0 .0 5 )。结论 :曲马多连续硬膜外术后镇痛效果确切 ,但使首次排气和排便时间延迟 ,并使血清MOT水平降低 ,恶心。
AIM: To observe the effect of continuous epidural analgesia (CEA) of tramadol on postoperative gastrointestinal function and serum motilin level in the patients with cholecystectomy. METHODS: Twenty eight ASAⅠ-Ⅱpatients (8 male, 20 female) aged 24-56 yr, scheduled for elective cholecystectomy under epidural anesthesia, were randomly divided into tramadol group (T, n=14) and control group (C, n=14). The combination of tramadol 800 mg+ bupivacaine 150 mg+ droperidol 5 mg, which diluted with normal saline to 100 ml and pumped 2 ml·h -1, was administered in group T. The combination in group C was bupivacaine 150 mg+ droperidol 5 mg. The VAS values, the first anorectum exhaust timing (FAET), and the time of the first eliminating stool timing (FEST) were recorded, and serum motilin level measured with radioimmunoassay at the different times after surgery. RESULTS: There was a significant difference in the mean VAS values between group T ( 1.2± 1.2) and group C ( 3.3± 1.3) (P< 0.05). The FAET and FEST were delayed in group T ( 56.8± 16.6) and ( 96.5± 19.7) h in comparison with group C ( 38.8± 14.7) and ( 75.6± 18.3) h (P< 0.05). The MOT level of group T decreased from ( 135.6± 22.8) pmol·L -1 to ( 78.3± 18.7) pmol·L -1 after analgesia (P< 0.05), and the change had a statistical significance (P< 0.05) between the two groups. A marked negative relationship was found between FAET, FEST and the MOT levels (r=- 0.47, P< 0.05). In addition, nausea, vomiting and somnolence occurred more frequent in group T than in group C. CONCLUSION: Tramadol shows a better postoperative analgesia effect in the patients with cholecystectomy, but it can delay FAET and FEST, decrease the serum MOT level, and increase the incidences of nausea, vomiting, somnolence, and urine retention.
出处
《中国临床药理学与治疗学》
CAS
CSCD
2003年第1期86-88,共3页
Chinese Journal of Clinical Pharmacology and Therapeutics
关键词
曲马多
疼痛
术后
硬膜外镇痛
胃肠功能
胃动素
tramadol
pain, postoperative
epidural analgesia
gastrointestinal function
motilin
