【摘要】 目的 比较与吗啡等效剂量及1.5倍等效剂量的曲马多，用于开胸术后PCIA的镇痛效价与副作用。方法 择期开胸手术老年病人108例，随机分为3组，每组36例。T 1 组:曲马多1000mg;T 2 组:曲马多1500mg;M组;吗啡100mg。3组泵内均加入氟哌利多5mg+格拉司琼3mg+生理盐水稀释至100ml。结果 术后镇痛24h用药量及PCA按压次数(D 1 )和实际有效次数(D 2 )、术后48h改变给药条件及总体满意度T 1 组与T 2 、M组比较差异有显著性(P<0.05)，而T 2组和M组比较差异无显著性(P>0.05)。M组副作用发生率高于T 1 、T 2 组。结论 曲马多用于老年人开胸术后PCIA其镇痛效果与用药剂量相关。与吗啡比较，等效剂量应该在15:1，虽镇痛效能较吗啡稍低，但足量应用曲马多可获得近似吗啡的镇痛效果，且副作用少于吗啡。

    关键词 等效剂量 曲马多 吗啡 老年人 PCIA

    Observation in the ill effect and valence of analgesia of tramadol used in PCIA for old patients after operation

    Shi Ying，Zhang Jiuli，Yang Shun

    Department of Anesthesiology，Tumor Hospital，Liaoning Province110042.

    【Abstract】 Objective Compare the ill effect and valence of analgesia of morphia with the same dosages and 1.5 times dosages of tramadol after the thoracotomy. Methods 108 old patients for thoracotomy were divided into 3 groups in average at random group T 1 1000mg tramadol; group T 2 tramadol 1500mg; group M: morphine 100mg. Every group is added Droperido l5mg+Granisetron 3mg+0.9% Saline and diluted to 100ml. Results The 24h’s medication of analgesia of post-operation and the times of using PCIA(D 1 )and the practice times of using PCIA(D 2 )and the administration conditions changing after 48h of the thoracotomy and satisfaction of group T 1 has notable difference compared with group T 2 and group M(P<0.05). Group T2 has no difference from group M(P>0.05). The incidence of ill effect in group M is higher than other groups. Conclusion The effect of analgesia of tramadol used by PCIA in the old patients after thoracotomy has correlation with the dosage. The tramadol’s equivalent dosage should be 15:1 with morphine. The effect of analgesia of tramadol is no less than that of morphine and the ill effect is less than morphine. ......