氯诺昔康超前镇痛对妇科手术后病人芬太尼镇痛影响的观察及护理

Observation and nursing on effect of preemptive analgesia with lornoxicam used in patient-controlled intravenous analgesia with fentanyl on patients undergoing gynecological surgery

目的 观察氯诺昔康超前镇痛对妇科剖腹手术后病人自控静脉镇痛（PCIA）芬太尼用量的影响，总结护理经验。方法 将40例ASAⅠ～Ⅱ级择期在硬膜外麻下行剖腹妇科手术的病人随机分成观察组和对照组，每组各20例。观察组于手术切皮前及关腹时分别静注氯诺昔康8mg。2组术毕均用芬太尼PCIA，镇痛配方为芬太尼10μg／kg，氟哌利多5mg，以生理盐水稀释至100ml，负荷剂量芬太尼1μg／kg，背景输注2ml／h，PCA每次1m1，锁定时间10min。镇痛期间定时行视觉模拟镇痛分级评分（VAS）。结果 2组病人镇痛效果接近，VAS无统计学差异（P〉0．05）；观察组24h内芬太尼用药量明显少于对照组（P〈0．01）。结论 氯诺昔康超前镇痛能明显减少妇科剖腹病人PCIA期间芬太尼用药量及不良反应。PCIA的观察及护理重点应放在呼吸、循环抑制副作用上，虽然发生率低，但可危及病人的生命安全；同时也应注意发生率较高的恶心呕吐、尿潴留及皮肤瘙痒等。其主要护理措施是做好预防及心理护理。

Objective To observe the influence of preemptive analgesia with lornoxicam used in patient--controlled intravenous analgesia with fentanyl on patients undergoing gynecological surgery, Methods 40 patients （ASAⅠ-Ⅱ） who received selective abdominal gynecological surgery under epidural block anesthesia were divided randomly into observation group and control group with 20 cases in each group, PCIA with fentanyl was given for all patients after operation. The analgesic prescription included fentanyl 10μg/kg and droperidol 5mg diluted by 0.9% sodium chloride injection to 100ml. A loading dose of fentanyl 1μg/kg with ondansetron 8 mg was injected and the continuous infused speed was 2ml/h, and the dose was 1 ml for one time and lockout 10 minutes interval. Patients in observation group were given additional treatment of lornoxieam 8 mg iv. before operation and at the end of operation. Vis ual analgesia score （VAS） was used to evaluate the effect of analgesia. Results Analgesic efficacy of two groups was almost same and there was no statistics difference in VAS （P〉 0. 05 ）. The total dosage of fentanyl of patients in observation group was less than that of the control group （P 〈 0.01）, Conclusions Preemptive analgesia with lornoxicam can decrease the dosage and side effects of PCIA with fentanyl significantly, The changes of patients＇ breath and circulation must be intensive care; Meanwhile, nausea and vomiting, urine retention and skin itching should he focused on and prevention as well as mental care is major nursing methods for these,