氟比洛芬酯用于瑞芬太尼麻醉术后镇痛的临床研究

Effects of flurbiprofen on the patients with postoperative hyperalgesia after remifentanil based anaesthesia

目的 评估氟比洛芬酯用于瑞芬太尼麻醉术后镇痛的临床效果。方法 60例接受腹部大手术的患者被随机分组，每组15例，分别接受：（1）术中瑞芬太尼0．05μg／（kg·min）（L组）。（2）术中瑞芬太尼0．40μg／（kg·min）（H组）。（3）麻醉诱导前静脉注射氟比洛芬酯100mg，术中瑞芬太尼0．05μg/（kg·min）（LF组）。（4）麻醉诱导前静脉注射氟比洛芬酯100mg，术中瑞芬太尼0．40μg/（kg·min）（HF组）。记录四组患者拔除气管导管后的口述疼痛评分，拔管后1、2、3、12、24h的视觉疼痛模拟评分（VAS）和48h的吗啡用量。结果四组间拔管后的1：3述疼痛评分差异无统计学意义；H组术后1、2、3h的VAS分别为（4．90±0．74）分、（4．80±0．92）分、（4．50±0．85）分，较其他三组明显升高，同时H组48h吗啡需要量为（7．30±1．64）mg，较其他三组明显增大（p〈0．05）。结论在手术中相对大剂量应用瑞芬太尼会诱发术后痛觉过敏，非甾体抗炎药氟比洛芬酯对瑞芬太尼麻醉术后疼痛具有明显的抑制作用。

Objective To evaluate the preventive effects of flurbiprofen on the patients with postop- erative hyperalgesia after large-dose remifentanil-based anesthesia. Methods Sixty patients undergoing major abdominal surgery were randomly assigned to 4 groups （n = 15）,group L received intraoperative remifentanil at 0.05 μg/ （ kg·min ）, group H received intraoperative remifentanil at 0.40 μg/ （ kg· min ）, group LF received intraoperative remifentanil at 0.05 μ g/（ kg·min ） and flurbiprofen 100 mg before anesthesia, group HF received intraoperative remifentanil at 0.40 μ g/ （kg·min ）, and flurbiprofen 100 mg before anesthesia. The four-level verbal rating scale after trachea extubation, VAS score at 1,2,3,12,24 hours after extubation,and morphine consumption at 48 hours after extubation were recorded. Results There was no significant difference in verbal rating scale among four groups. The VAS at 1,2,3 hours in group H were （4.90 ± 0.74）, （4.80± 0.92）, （4.50 ±0.85）scores after extubation ,they were higher than those in the other three groups. Morphine consumption in group H was significantly higher than that in the other three groups （P 〈 0.05 ）. Conclusion Flurbiprofen can attenuate postoperative hyperalgesia after large-dose remifentanil-based anesthesia.