关键词: 曲马多, 疼痛, 术后, 硬膜外镇痛, 胃肠功能, 胃动素

Abstract: 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 ASA Ⅰ - 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 5mg.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.

Key words: tramadol, pain, postoperative, epidural analgesia, gastrointestinal function, motilin