氟比洛芬酯减轻七氟烷全麻下神经外科术后躁动临床研究

Flurbiprofen axetil reduces postoperative agitation after sevoflurane anesthesia in neurosurgery

目的观察并评价氟比洛芬酯减轻七氟烷全麻下神经外科术后躁动的临床效果、不良反应及临床作用和安全性。方法ASAⅠ-Ⅱ级神经外科手术住院患者60例,手术时间（230±58）m in,随机分为氟比洛芬酯组（F组,n=30）和对照组（C组,n=30）。2组患者均静脉注射依托咪酯0.03 mg·kg^-1、芬太尼5μg·kg^-1、阿曲库铵1 mg·kg^-1诱导,术中吸入七氟烷,静脉输注丙泊酚维持麻醉。手术结束前60 m in F组静脉注射氟比洛芬酯100 mg,C组静脉注射等容积的脂肪乳剂。术中监测平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）、呼吸频率（RR）、VAS镇痛评分、Ram say镇静评分及不良反应,观察术后躁动发生率和躁动程度。结果①F组患者术后躁动发生率明显低于C组,C组患者术后中、重度躁动多见（P〈0.05）;②与F组相比,C组患者术后RR、MAP、HR明显增高（P〈0.05）;③F组患者术后VAS评分明显低于C组（P〈0.05）,2组Ram say评分差异无显著性（P〉0.05）;④2组患者术后未见恶心、呕吐、消化道出血、呼吸抑制等不良反应,C组2例患者术后切口渗血,经降压处理后缓解。结论术中静脉注射氟比洛芬酯100 mg可减轻七氟烷全麻下神经外科术后躁动,未见不良反应。

Objective To evaluate the preventive effect and safety of flurbiprofen axetil on postoperative agitation. Methods Sixty patients of ASA Ⅰ-Ⅱ undergoing neurosurgery were randomly divided into 2 groups （ n = 30 each ） ： flurbiprofen axetil group （F） and control group （C）. In both groups, the anesthesia was induced with etomidate （0.03 mg·kg^-1 ） , fentanyl （5 μg·kg^-1 ） and atracurium （ 1 mg·kg^-1 ） , and was maintained with sevoflurane, propofol and atracurium. In group F, flurbiprofen axetil injection 100 mg was administrated 60 minutes before the end of operation, while to the patients in group C was given an equal volume of fat emulsion IV. The heart rate （HR） , mean arterial blood pressure （MAP） , respiratory rate （RR） , saturation of pulse oxygen （SpO2 ） and adverse effects were monitored during and after operation. The incidence and the degree of postoperative agitation were recorded. The quality of analgesia （VAS） and sedation （Ramsay method） was scored after extubation. Results The incidence of postoperative agitation was lower in group F than in group C after discontinuation of sevoflurane （P 〈 0.01 ）. The RR, HR and MAP were significantly higher in group C than in group F after operation （ P 〈 0.05 or 〈 0.01 ）. The VAS value in group F was significantly lower than that in group C after extubation （P 〈 0.05 or 〈 0.01 ）. No nausea -vomiting, digestive tract bleeding or dyspnea was encountered in either group; oozing of blood from incision in 2 patients of group C was remedied by controlled hypotension. Conclusion It is safe and feasible to give flurbiprofen axetil （ 100 mg） to reduce postoperative agitation after sevoflurane anesthesia.