氟比洛芬酯对老年胸部手术后的镇痛效果及对呼吸功能的影响

Effects of Flurbiprofen Axetil on Postoperative Analgesia Efficacy and Respiratory Function in Elderly Patients with Thoractomy

目的观察氟比洛芬酯复合小剂量芬太尼用于病人自控镇痛(PCA)对老年胸部手术后的镇痛效果及对呼吸功能的影响。方法40例ASA I^II级择期开胸手术的食管癌病人随机分为病人自控硬膜外镇痛(PCEA)组和病人自控静脉镇痛(PCIA)组,每组20例。药液配方PCIA组为氟比洛芬酯200 mg+芬太尼0.3 mg+恩丹西酮8 mg,PCEA组为0.15%罗哌卡因+芬太尼0.3 mg+恩丹西酮8 mg。均用生理盐水稀释到100 ml。记录术后4、8、12、24、48 h的视觉模拟评分(VAS)、布氏评分(BCS)、镇静评分(RSS)、病人对术后镇痛总体满意度评分及不良反应。并于术前和术后24h测定肺功能和血气分析的变化。结果两组VAS评分PCIA组高于PCEA组,BCS评分PCIA组低于PCEA组,但差异无统计学意义(P>0.05),RSS评分于术后4 h PCIA组明显增高(P<0.05),病人对术后镇痛总体满意程度评估优秀者PCEA组明显增多但两组间差异无统计学意义(P>0.05)。PCEA组呼吸功能改善明显优于PCIA组(P<0.05)。结论氟比洛芬酯复合小剂量芬太尼PCIA对于老年胸部手术术后镇痛安全有效,改善了呼吸功能,综合镇痛总体质量和呼吸功能的改善仍不及PCEA,但PCEA需加强硬膜外导管的管理。

Objective To observe the effects of flurbiprofen axetil combined with a small dose of fentanyl on postoperative analgesia efficacy and respiratory function in elderly patients with thoractomy. Methods Forty elderly patients with e.sophageal cancer, ASA grade Ⅰ～Ⅱ scheduled for thoractomy were randomly divided into two groups; Patient controlled intravenous analgesia （PCIA） group （n=20） and patient controlled epidural analgesia（PCEA） group （n=20）. the PCIA solution consists of flurbiprofen axetil 200 mg ＋ fantanyl 0.3 mg ＋ endansetron 8 mg. The PCEA solution consists of 0.15 % ropivacaine ＋ fentanyl 0.3 mg ＋ endansetron 8 mg. The drugs in each group were diluted with normal saline to 100 ml. Visual analog scale（VAS）, Bruggrmann comfort score （BCS）, Rawsay sedation score（RSS）, Patient＇s overall satisfaction, and side effects were evaluated. at 4,8, 12,24 h. The respiratory function and blood gas analysis were measured before and 24 h after operation. Results VAS was higher and BCS was lower in PCIA group than that in PCEA group but there were no significant difference in both groups, RSS was higher in PCIA group than that in PCEA group at 4h （P〈 0.05）, Patient＇s overall satisfaction to analgesic therapy were similar in Both groups, the lung function was significantly better in PCEA group than in PCIA group （P 〈 0.05）. Conclusions in elderly patient for aher thoractomy flurbiprofen axetil combined a small dose fentanyl for PCIA can effectively and safely used, h can improve the respira＇tory fanction. Synthetical overall quality to analgesic therapy and improve the respiratory function not as good as in PCEA group, But epidural catheter need enhancement management.