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中国临床药理学与治疗学 ›› 2003, Vol. 8 ›› Issue (1): 86-88.

• 研究原著 • 上一篇    下一篇

曲马多硬膜外术后镇痛对胃肠功能及血清胃动素的影响

戴泽平, 陈永权, 鲁卫华, 金孝岠, 张鹤   

  1. 皖南医学院弋矶山医院麻醉科, 芜湖 241001, 安徽
  • 收稿日期:2002-07-04 修回日期:2002-08-21 发布日期:2020-11-25
  • 通讯作者: 戴泽平, 男, 硕士, 副教授, 研究方向:疼痛治疗。Tel:0553-5738856-2321 Email:hwldzp@sohu.com

Effect of continuous epidural analgesia of tramadol on postoperative gastrointestinal function and serum motilin level

DAI Ze-Ping, CHENG Yong-Quang, LU Wei-Hua, JIN Xiao-Ju, ZHANG He   

  1. Department of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui
  • Received:2002-07-04 Revised:2002-08-21 Published:2020-11-25

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28 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800 mg +布吡卡因150 mg +氟哌利多5 mg, 总量100 ml, 泵速2 ml·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 ±1.26), 两组比较具有显著性差异(P <0.05)。首次排气、排便时间3 药联用组分别为(56.8 ±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 <0.05)。3 药联用组MOT 水平从镇痛前的(135.6 ±22.8) pmol·L-1 降至(78.3 ±18.8) pmol·L-1 (P <0.05), 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 <0.05。排气、排便时间与MOT 水平呈显著性负相关(r=-0.47, P <0.05)。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 <0.05)。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、呕吐和嗜睡的发生率亦增加。

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

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