氯诺昔康复合芬太尼和曲马多病人自控镇痛的比较

The Comparison of Patient-Controlled Analgesia with Lornoxicam in Combination with a Small Dose of Fentanyl Versus Tramadol

目的:评价氯诺昔康复合小剂量芬太尼与曲马多比较病人术后静脉自控镇痛(PCIA)中的疗效与不良反应。方法:80例ASAⅠ-Ⅱ级择期行乳腺癌根治术患者,随机分为实验组和对照组。实验组以氯诺昔康48mg和芬太尼0.3mg用生理盐水稀释至100ml。对照组以曲马多1000mg和氟哌利多5mg用生理盐水稀释至100ml。拔除气管导管后开通PCIA,预注泵内液4ml。PCIA设计2ml/h,PCA每次0.5ml,锁定时间15分钟。记录PCA次数和术后4,8,12,24,48小时视觉模拟镇痛评分(VAS)及不良反应发生。结果:两组镇痛效果VAS评分无统计学差异(P>0.05),但实验组患者PCA次数明显少于对照组(P<0.05),实验组不良反应恶心、呕吐、眩晕、嗜睡等发生率低于对照组(P<0.05)。结论:氯诺昔康复合小剂量芬太尼可获得良好的镇痛效果和较少的不良反应,可作为多模式镇痛药物选择。

Objective： To evaluate the effects and the side effects of lornoxicam in combination with a small dose of fentanyl versus tramadol for postoperative patient- controlled intravenous analgesia （PCIA）. Methods： 80 ASA Ⅰ - Ⅱ patients scheduled for radical mastectomy were randomly divided into the study group and the control group. The patients in the study group were administrated with 48rag lornoxicam and 0.3mg fentanyl which were diluted with 0.9% NS to 100ml, while the patients in the control group were administrated with 1000mg tramadol and 5mg droperidol which were diluted with 0.9% NS to 100ml. All of the patients received PC1A soon after extubation （background infusion 2ml/h, bolus dose 4ml, PCA 0.5ml/time, lock - pump interval 15min）. The times of PCA, pain score （VAS） and the incidence of side effects were recorded at 4, 8, 12, 24 and 48 hours after operation. Results： There was no significant difference in VAS between the two groups （ P 〉 0.05）, but the times of PCA and the incidence of nausea, vomiting, vertigo and lethargy in the study group were obviously less than those in the control group （P〈0.05）. Conclusion： Lornoxicam in combination with a small dose. of fentanyl produced favourable analgetie effects and less incidence of the side effects, which could be a choice for the multiple pattern of analgetics.