舒芬太尼、氟比洛芬酯及其联合用药用于腹部手术后患者静脉自控镇痛的临床研究

Effect of sufentanil and flurbiprofen axetil used alone or in combination for patient-controlled intravenous analgesia following abdominal surgeries

目的比较舒芬太尼、氟比洛芬酯及其联合用药用于腹部手术后患者静脉自控镇痛(PCIA)的有效性和安全性。方法80例美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级、择期行腹部手术的患者,均采用静脉-吸入复合麻醉,术后行PCIA。随机均分为4组:A组予舒芬太尼150μg+0.9%氯化钠溶液+氟哌利多5 mg,B组予氟比洛芬酯100 mg+0.9%氯化钠溶液+氟哌利多5 mg,C组予氟比洛芬酯100 mg+舒芬太尼75μg+0.9%氯化钠溶液+氟哌利多5 mg,D组予氟比洛芬酯200 mg+0.9%氯化钠溶液+氟哌利多5 mg,容量均为100 mL。PCIA工作方式采用持续背景剂量(2 mL/h)配合单次按压剂量(1.5 mL),锁定时间为20 min。采用疼痛视觉模拟评分(VAS评分)和Ramesay镇静评分评估患者术后48 h内的疼痛程度及镇静情况,同时记录48 h内总的按压次数及不良反应发生情况。结果4组患者均获得良好镇痛效果,B和D组患者术后各时间点的疼痛VAS评分稍高于A和C组,但差异均无统计学意义(P值均>0.05)。B和C组患者术后2和4 h的Ramesay镇静评分明显低于A组(P值均<0.05),略低于D组(P值均>0.05),术后8 h及以后虽仍偏低,但4组间的差异均无统计学意义(P值均>0.05)。4组48 h内的中位PCIA按压次数的差异均无统计学意义(P值均>0.05)。观察期间A组恶心、呕吐、嗜睡和皮肤瘙痒等不良反应发生率略高于B、C和D组,但4组间的差异均无统计学意义(P值均>0.05)。4组镇痛期间均未发生呼吸抑制、异常出血等并发症。结论氟比洛芬酯联合舒芬太尼应用于腹部手术后PCIA的效果良好,相对于单独应用阿片类(舒芬尼)或非甾体类抗炎药(氟比洛芬酯),两者联合应用的术后镇痛效果相同,但可显著减少阿片类药物的用量和降低不良反应的发生率。

Objective To evaluate the efficacy and safety of sufentanil and flurbiprofen axetil, used alone or in combination, for postoperative patlent-controlled intravenous analgesia （PCIA） in patients undergoing abdominal surgeries. Methods Eighty ASA 1 - ill patients undergoing elective abdominal surgeries were randomized equally into 4 groups （groups A, B, C, and D）, and all received intraoperative intravenous combined with inhalation anesthesia and postoperative PCIA. For postoperative PCIA, the patients in group A received a protocol of sufentanil （150 l^g）＋ droperidol （5 mg） ＋0.9% NaCl solution, those in group B had a protocol consisting of flurbiprofen axeyil injection （100 mg）＋droperidol （5 mg）＋0.9% NaCl solution, those in group C had flurbiprofen axeyil injection （ 100 mg） ＋ sufentanil （75 μg） ＋ droperidol （5 mg）＋ 0.9 % NaCl solution, and those in group D received flurbiprofen axeyil injection （200 mg）＋droperidol （5 mg）＋0. 9 % NaCl solution. All the anesthetic agents were diluted to 100 mL and infused by a pump at the background dose rate of 2 mL/h with a patient-controlled bolus of 1.5 mL and the lock out time of 20 min. The visual analogue scale （VAS） and Ramsay scores were used to evaluate the analgesic effect at 2, 4, 8, 12, 24 and 48 h after surgery, and the number of button-pressing times during PCIA and the adverse effects associated with PCIA were recorded in the 48 h postoperatively. Results All the patients showed good pain relief with PCIA, but patients in groups A and C had slightly lower VAS scores than those in groups B and D, which, however, did not indicate a statistically signifi cant difference （P〉0.05）. In groups B and C, the average Ramsay score was significantly lower than that in group A （P〈0.05）, but only slightly lower than that in group D （P〉0.05） at 2 and 4 h after the operation. At 8 h, the average Ramsay score was still lower in groups B and C, but the differences were not significant （P〉0.05）. Within 48 h after the operation, no significant difference was found in the number of times of button pressing during PCIA between the 4 groups. The PCIA protocol in group A was associated with slightly, but not significantly, higher incidences of nausea, voiniting, lethargy and skin itching than the protocols in the other 3 groups （all P〉0.05）. Respiratory inhibition or abnormal bleeding occurred in none of the cases in the 4 groups. Conclusion PCIA with a combination of flurbiprofen axeyil and low-dose sufentanil produces better analgesic effect than sufentanil or flurbiprofen axeyil used alone, and can significantly reduce the dose requirement of sufentanil as well as its associated adverse effects.