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目的 :比较曲马多、哌替啶用于小儿硬膜外腔术后镇痛效果和副作用。方法 :对 80例 (ASAⅠ -Ⅱ级 )行硬膜外麻醉的患儿随机分成 4组行术后硬膜外腔镇痛。A组 (n =2 0 )曲马多 1 5mg/kg + 0 12 5 %布比卡因的镇痛液 5ml,B组 (n =2 0 )曲马多 1mg/kg + 0 12 5 %布比卡因的镇痛液 5ml;C组 (n =2 0 )哌替啶 0 75 %mg/kg+ 0 12 5 %布比卡因镇痛液 5ml;D组 (n=2 0 )单纯 0 12 5 %布比卡因 5ml。方法 :手术结束前给予镇痛液 ,观察给药后 30分钟内有血压心率、氧饱和度 (SPO2 )和呼吸频率 ,并记录疼痛完全缓解、明显缓解维持进间、镇痛效果、副反应。结果 :四组给药后 :BP、HR、RR无明显变化 ,C组 (哌替啶组 )SPO2 给药后由 97 2 %降至94 8%,而A、B、D三组SPO2 无明显改变。疼痛完全缓解时间A组 >C组 >B组 >D组 ,且曲马多用量越大 ,镇痛维持时间越长。恶心呕吐以A组为高 ,但组间无显著差异。结论 :曲马多的止痛效果、安全性 ,以及对呼吸抑制小可以使之成为小儿术后镇痛的有效替代剂 ,联合应用低浓度局麻药为小儿术后镇痛提供又一有效安全的选择。随着曲马多应用剂量的增大 (在推荐剂量下 )镇痛效果越好和维持时间越长 ,副反应也相应增加 ,这点 ,应给予注意。
Objective: To compare the analgesic effects and side effects of tramadol and meperidine in pediatric epidural. Methods: Eighty children (ASAⅠ-Ⅱ grade) undergoing epidural anesthesia were randomly divided into four groups. Postoperative epidural analgesia was performed. Group A (n = 20) tramadol 1 5mg / kg + 0,12 5% bupivacaine analgesic 5ml, group B (n = 20) tramadol 1mg / kg + 0 12 5% cloth 5 ml of analgesic solution of bupivacaine, 5 ml of analgesic solution of bupivacaine, 5 ml of bupivacaine 0 75% mg / kg + 0,125% of group C (n = 20) 5% bupivacaine 5ml. Methods: Analgesia was given before the operation was finished. Blood pressure, heart rate, oxygen saturation (SPO2) and respiratory rate were observed within 30 minutes after the operation. The pain relief was recorded and the pain relief and side effects were relieved. Results: There were no significant changes in BP, HR and RR after four administrations. The SPO2 in C group (pethidine group) dropped from 97 2% to 94 8% after administration, while the SPO2 in A, B and D groups were not significant change. Pain relief time A group> C group> B group> D group, and the greater the amount of tramadol, analgesic longer. Nausea and vomiting in group A as high, but no significant differences between groups. Conclusion: The analgesic effect, safety and small inhibition of tramadol can make tramadol an effective substitute for postoperative analgesia in children, and the combination of low concentration of local anesthetic provides another effective and safe choice for pediatric postoperative analgesia . As tramadol dose increases (at the recommended dose) the better the analgesic effect and the longer the maintenance time, the side effects also increased accordingly, this point, we should pay attention.