氯诺昔康全子宫切除术后自控镇痛及其对β内啡肽的影响

Analgesia effects of lornoxicam on postoperative total hysterectomy pain and influence on beta-endorphin serum concentration

目的:评价氯诺昔康用于全子宫切除术后自控镇痛(PCA)的效果和安全性,并观察其对β内啡肽水平的影响。方法:60例全麻下行全子宫切除术术后中度以上疼痛的病人随机分为氯诺昔康组和吗啡组。根据需要启动PCA泵,分别给予氯诺昔康每次0.8mg,吗啡每次1mg,锁定时间5min。以疼痛缓解程度、疼痛缓解总和及24h镇痛总体效果来评价镇痛效果,同时测定血浆β内啡肽、皮质醇浓度。结果:氯诺昔康组与吗啡组的疼痛缓解总和及镇痛总体印象评分无显著差异(P>0.05),吗啡组起效早于氯诺昔康组(P<0.01)。氯诺昔康组的呕吐的发生率明显低于吗啡组(P<0.01)。2组血小板聚集率无显著差异(P>0.05)。启动镇痛泵后3h,2组β内啡肽皆有显著上升,2组间没有显著差异(P>0.05)。结论:氯诺昔康用于全子宫切除术后PCA,效应与吗啡相当,不良反应较少。氯诺昔康可引起β内啡肽的显著升高,其机制有待探讨。

AIM：To assess the analgesic efficacy and safety of lomoxicam on patient-controlled analgesia （PCA） undergoing hysterectomy and influence of lomoxicam on beta-endorphin serum concentration.METHODS： Sixty patients scheduled for abdominal hysterectomy under general anaesthesia were randomly divided into lornoxicam group and morphine group.According to the necessity, two drugs administered ivvia a patient-controlled analgesia for up to 24 h, postoperatively （ lornoxicam group, bolus = 0.8 mg lornoxicam , lock-out time 5 min. monphine group, bolus =1 mg morphine, lock-out time 5 min）. Efficacy was assessed by comparing hourly pain relief （PAR）, total pain relief （TOTPAR）and patient＇s evaluation of the efficacy of PCA received. Adverse reactions like vomiting, respiratory depression and abdominal distension were also observed. Platelet aggregation with functions of kidney and liver were monitored. Beta-endorphin and cortisol concentrations were measured before and after the operation. RESULTS. There were no statistically significant difference between the two groups in TOTPAR and patient＇s general evaluation of the efficacy （P 〉 0.05 ）. Lornoxicam caused fewer adverse reactions such as vomiting than morphine （ P 〈 0.01 ）.Statistical analysis also revealed no significant difference in platelet aggregation （P 〉 0.05 ）. Concentrations of beta-endorphin increased significantly in both groups 3 h after PCA start （ P 〈 0.01 ）, and there were no statistically significant difference between the two groups （P 〉 0.05）. CONCLUSION ： Lornoxicam offers an useful alternative to morphine for the PCA withless adverse reactions. Lornoxicam can induce the notable increase of beta-endorphin under stress which needs further study.