氟比洛芬酯对经腹子宫全切除术后病人PCA效应的影响

Effect of Flurbiprofen Axetil on Patient Controlled Analgesia after Hysterectomy

目的：比较研究硬膜外持续输注0.2％左旋布比卡因期间新型非甾体类靶向镇痛等一氟比洛芬酯静脉病人自控镇痛（PCA）的临床效应和不良反应，并与氯诺昔康和吗啡作比较。方法：选择择期经腹子宫全切手术病人60例（ASAⅠ-Ⅱ），随机分三组；氟比洛芬酯组（F组），氯诺昔康组（L组）和吗啡组（M组）。采用双泵法行双盲对照观察。其中A泵三组均为硬膜外持续输注0.2％左旋布比卡因4ml/h。B泵F组以氟比洛芬酯PCIA强化；L组B泵以以氯诺昔康PCIA强化；M组B泵以吗啡PCIA强化。镇痛效应采用视觉模拟评分（VAS），Ramesay镇静评分，术后运动神经阻滞恢复评分（改良Bromge分级）和病人对PCA综合满意度评分，并记录订后1h、2h、4h、6h、8h、12h、16h、18h、24hPCA泵的按压次数（D1）与实际进入次数（D2），和肛门排气时间及可能出现的不良反应。结果：三组病人的一般飞速相似，24小时硬膜外左旋布比卡因的使用剂量为192mg，三组病人未按压PCA泵的病人各为2例（10％），静脉用药量分别为（53.9±2.1）mg（F组）、（11.4±2.8）mg（L组）、（4.7±3.5）mg（M组）。在相同时间段内三组间VAS，Ramesay镇静评分，Bromage分级及D1／D2比值均相似（P〉0.05）。结论：在0.2％左旋布比卡因硬膜外持续输注（4ml/h）的基础上，新型靶向非甾体类镇痛药氟比洛芬酯与氯诺昔康和吗啡静脉PCA均能达到辅助镇痛的效果，静脉PCA氟比洛芬酯与吗啡的比例约为12：1；氯诺昔康与吗啡的比例约为2：1。

Ojective： me compare anatgesic and side effects of flurbiprofen axetil, lomoxicam and morphine used for paticent controlled intravenous analgesia. Methods： sixty ASAⅠ-Ⅱ tpatients undergoing elective abdominal hysterectomy under epidural anesthesia were randomly divided into three groups; group flurbiprofen axetil （n=20） group lornoxicam （n=20） and group morphine （n=20）. Two Graseby pumps were used by every patient, pump A was for continuous epidural Infusion of 0.2% levobupivacaine at rate of 4ml/h among three groups. Another pump （pump B）, was for patient controlled intravenous analgesia PCIA of Purbiprofen, axetil, lornoxicam and morphire, respectivety. If the patient still complactled of pain after pressing PCA beyond 10 times（VAS〉 5）. an additional epidural morphine 1 mg was given the analgesic effects were assessed by VAS score of pain, Ramesay sedation score, modified Bromage score, patients satisfaction for PCA. the number of pressing of PCIA pump by the patient （D1） at th. 2h 4h, 8h, 8h 12h, 16h. 18h. 24h, the number of bolus dose delivered （D2） and the time when the patient passed gas and probable complications were recorded. Results The general state of health was similar among three groups, the amount of levobupivacaine censumed was 192mg in three groups. The amount of flurbiprefen axetil consumed was （53.9 ± 2.1）rag in group flurbiptefen axetil the amount of lornoxicam consumed was （11.4±2.8）mg in group lornoxicam and the amount of morphine consumed was （4 7 ± 3.5）mg in group morphine, There was no statistically significant difference in VAS. Ramesay sedation score modified Bromage score and D1/D2 during the same duration among three groups. Conclusion： Flurbiprofen axetil, a new type target painkiller, could achive the same auxiliary analgesic effect as lornoxicam and morphine on the base of the continuous epidural infusion of 0.2% levobupivacaine, the ratio of flurbiprofen axetU to morphine is 12：1 in PCIA.