微创椎间盘手术后氯诺昔康持续静脉输注镇痛的临床观察

The efficacy of patient controlled analgesia with intravenous Lornoxicam after microsurgery of lumbar disc

目的观察微创椎间盘手术后氯诺昔康持续静脉输注(PCIA)镇痛的有效性与安全性。方法选择ASAⅠ~Ⅱ级,择期行微创椎间盘髓核摘除术患者120例,随机分成M组(吗啡组,n=40)、L组(氯诺昔康组,n=40)和LF组(氯诺昔康+芬太尼组,n=40)。三组均采用PCIA,总量80ml,背景输注2ml/hr,PCA2ml,锁定时间10min,负荷量经硬膜外给予0.75%Bupivacaine4ml。配方为M组吗啡0.25mg/ml,L组氯诺昔康0.5mg/ml,LF组氯诺昔康0.5mg/ml+芬太尼5μg/ml。观察治疗开始后1h、4h、8h、16h、32h视觉模拟法疼痛评分(VAS)并记录治疗期间病人尿潴留、恶心、呕吐、皮肤瘙痒等不良反应的发生情况。结果在治疗开始后1h、4h三组镇痛效果无显著差异(P>0.05),但随后各时间点L组VAS评分显著高于其他两组(P<0.05),M组和LF组VAS评分无显著差异(P>0.05)。而不良反应发生情况L组、LF组明显低于M组(P<0.05),差异具有显著性意义。结论在微创椎间盘手术后中到重度疼痛中,氯诺昔康复合芬太尼持续静脉输注比氯诺昔康单独使用镇痛效果好,与吗啡具有同等的镇痛效果,而尿潴留、恶心、呕吐、皮肤瘙痒不良反应较少发生,是一种较好的镇痛方法。

Objective To observe the efficacy and safety of patient controlled intravenous analgesia(PCIA) with Lornoxicam after microsurgery of lumbar disc. Methods 120 ASA I^II patients, undergoing microsurgery of lumbar disc were randomly allocated into three groups: M group which consist of morphine 0.25mg/ml, L group which consist of Lornoxicam 0.5mg/ml, LF group which consist of fentanyl 5μg/ml and Lornoxicam 0.5mg/ml, with 40 patients in each group. All the patients were given intravenous analgesics by PCA pump with background infusion rate 2ml/h, bolus 2ml, lockout time 10min, the total PCA volume diluted by normal saline was 80ml. Loading dose of 4ml 0.75% Bupivacaine were injected into epidural space at the end of surgery. VAS pain scores were observed at postoperative 1,4,8,16 and 32 hours. The side effects such as nausea, vomiting, pruritus and urine retention were also observed during postoperative analgesia period. Results There were no significant difference of analgesic effect among the three groups at postoperative 1h and 4h. VAS pain scores in group L were higher than those of the other groups at postoperative 8,16 and 32 hours. The incidence of side effects in Group M were significantly higher than those of the other groups. Conclusion Patient controlled intravenous Lornoxicam combined with fentanyl could provide a satisfactory pain relief effect, moreover, the incidence of the side effects could be minimized.