氯诺昔康对术后病人镇痛中吗啡的节俭作用

Morphine-sparing effect of lornoxicam for postoperative analgesia

目的:探讨氯诺昔康用于术后病人自控静脉镇痛吗啡的节俭作用。方法:选择ASAI～II级择期行上腹部手术的患者69例,随机分成3组,术后均采用病人自控静脉吗啡镇痛。M组:术毕缝皮时开启镇痛泵。L2组:术毕开启镇痛泵,术毕缝皮时及术后8h各静脉注射氯诺昔康8 mg。L3组:术毕开启镇痛泵,术毕缝皮时、术后8h及术后16 h各静脉注射氯诺昔康8 mg。镇痛药液配制如下:吗啡0.25 mg/ml,背景输注速度1 ml/h,病人自控量(PCA)4 ml,锁定时间5 min。术后4、24、48 h随访,采用视觉模拟评分法(VAS)评估镇痛效果,并记录镇痛药物用量和不良反应。结果:各组24 h和48 h VAS评分差异无显著性(P>0.05)。24 h和48 h吗啡总量、PCA按压次数和有效次数M组最多,L2其次,L3组最少,M组分别与L2组、L3组相比差异有显著性(P<0.01)。恶心呕吐和嗜睡的发生以M组最多,L2组和L3组均较少。头晕的发生3组相同。结论:氯诺昔康用于术后病人自控静脉镇痛,能够节俭吗啡的用量,减少吗啡的不良作用,提高术后镇痛质量。

Objective ：To investigate the morphine-sparing effect of intravenous lomoxicam for postoperative patient-controlled anal- geaia（PCIA）.Methods：69 patients （ASAⅠ-Ⅱ） undergoing selective upper abdominal procedure were randomly divided into three groups： morphine alone 0.25 mg·ml^-1 at the end of the procedure （group M）,adding lomoxicam 8rag at the end of the procedure and at the 8 hours after operation to the morphine regimen respectively（group L2） or adding lomoxicam 8 nag at the end of procedure and at the 8 hours and 16 hours after operation to the morphine regimen respectively （group L3）,VAS were used to evaluate the analgesic response.Results：Patients in the three analgesic groups did not show significant differences in the VAS values （P〉0.05）.Total morphine consumption,PCA pressing times and effective times in the patients in group M were significantly more than those in group L2 and group L3 （P〈0.05）. The incidence of nausea and lethargy was highest in group M, and the incidence of dizziness was the same in all the group. Conclusion：The dual add-on postoperative intravenous administration of lomoxicam to the morphine regimen can spare morphine consumption and decrease side effects.