氯诺昔康复合小剂量芬太尼用于术后静脉镇痛

Application of intravenous lornoxicam combined with fentanyl for postoperative analgesia

目的 比较氯诺昔康联合小剂量芬太尼与单纯芬太尼术后静脉镇痛的临床效应。方法 选择行腹部及四肢手术后患者 180例 ,随机分为三组 ,每组 6 0例 ,均以一次性镇痛泵 (1ml/h)行静脉术后镇痛。F组 :芬太尼 0 2 5 μg·kg 1·h 1;LF组 :氯诺昔康 15 μg·kg 1·h 1+芬太尼 0 1μg·kg 1·h 1;L组 :氯诺昔康 2 0 μg·kg 1·h 1。观察各组患者 6 0h内的镇痛评分 (VAS)及并发症的发生情况。结果 三组患者的静息镇痛评分在 12h内 ,LF组明显低于F组和L组 (P <0 0 5 ) ,而在 12h后无显著差异 (P >0 0 5 ) ;LF组和L组恶心呕吐、皮肤瘙痒、注射部位疼痛、头晕、嗜睡发生率明显低于F组(P <0 0 1) ;三组中均无呼吸抑制或胃肠道出血发生。结论 用氯诺昔康复合芬太尼行术后静脉镇痛可明显减少芬太尼的用量 ,镇痛效果明显优于单纯芬太尼或氯诺昔康。

Objective To compare analgesic efficacy and complications of intravenous postoperative analgesia with lornoxicam combined with a small dose of fentanyl and with fentanyl or lornoxica alone. Methods One hundred and eighty postoperative patients were randomly divided into three groups with 60 cases each. Fentanyl 0.25 μg·kg -1·h -1 was used in group F, fentanyl 0.1 μg·kg -1·h -1plus lornoxicam 15 μg·kg -1·h -1in group LF, and lornoxicam 20 μg·kg -1·h -1in group L.The drugs in each group were diluted to 60 ml and infused by a disposable perfusion pump in a rate of 1 ml/h.The visual analog scale(VAS),incidence of nausea, vomiting, itching, injection site pains, dizziness, somnolence and respiratory depression were recorded during the period of postoperative 60 hours .Results The VAS of group LF during the first 12 hours was significantly lower than that of group F and group L(P<0.05),which became similar 12 hours later.The accidences of nausea, vomiting, itching, injection site pains, dizziness, somnolence in group LF and group L were also significantly less than those in group F(P<0.01).No respiratory depression or gastrointestinal bleeding occurred in three groups. Conclusion Intravenous postoperative analgesia with lornoxicam combined with fentanyl has a better analgesic effect than that with fentanyl or lornoxicin alone, and can reduce fentanyl requirement and its side effects.