氯诺昔康复合吗啡在胸科术后病人自控镇痛中的应用

Application of Lornoxicam and Morphine on Postoperative Patient-Controlled Analgesia

目的评价氯诺昔康复合吗啡在胸科术后病人自控静脉镇痛(PCIA)中的效果和安全性。方法择期行开胸手术病人90例,随机分成3组,每组30例。F组:氯诺昔康组20μg·kg-1·h-1;LF组:氯诺昔康组15μg·kg-1·h-1+吗啡10μg·kg-1·h-1;L组:吗啡25μg·kg-1·h-1。3组均以0.9%氯化钠溶液配至100ml,手术结束前10min静注负荷剂量镇痛药物(F组与LF组氯诺昔康0.16mg/kg,L组吗啡0.1mg/kg),持续输注速率2ml/h,单次PCA剂量1.0ml,锁定时间15min。观察各组病人48h镇痛评分(VAS),病人对镇痛总体印象评分及不良反应的发生情况。结果3组患者术后8、16h的VAS评分间差异有显著性意义(P<0.05);而在16h后差异无显著性意义(P>0.05);病人对镇痛治疗总体印象评价3组间差异无显著性意义(P>0.05);3组恶心、呕吐、皮肤瘙痒、头晕、嗜睡的发生率间差异有显著性意义(P<0.05)。结论氯诺昔康复合吗啡术后PCIA镇痛效果优于单纯吗啡或氯诺昔康,不良反应较少。

Objective To evaluate the efficacy and safety of lornoxicam and morphine in patient - controlled intravenous analgesia （PCIA） after chest surgery. Methods 90 patients were randomly divided into three groups with 30 cases each. Lornoxicam 20μg·kg^-1·h^-1 was used in group F, morphine 10 μg·kg^-1·h^-1 plus lornoxicam 15 μg·kg^-1·h^-1 in group LF, and morphine 25μg·kg^-1·h^-1 in group L. The drugs in each group were diluted to 100 ml. A loading dose of lornoxicam 0. 16mg/kg in group F and in group LF and tramadol I mg/kg in group L was given intravenously 10 minutes before the end of operation. PCIA parameters were a bolus dose of 1ml, lockout interval of 15 minutes and continuous infusion of 2 ml/h. The efficacy of analgesia was assessed by analog scale （VAS） and patient global impression score of PCIA, and side effects were observed during the period of postoperative 48 hours. Results The VAS of group LF during the 8. 16hours was significant lower than that of group F and group L （ P 〈 0. 05 ）, which became similar 16 hours later. And there is no significant difference in patient global impression score among the three groups. The accidences of nausea, vomiting, itching, dizziness, somnolence in group L were also significantly higher than those in group LF and group F （ P 〈 0.05 ）. Conclusion Intravenous postoperative analgesia with lornoxicam combined with morphine has a better analgesic effect than that with morphine or lornoxicam alone, and can reduce its side effects.