氯诺昔康对心内直视手术后患者自控镇痛效应的影响

Effects of lornoxicam on patient controlled analgesia in patients after open heart surgery

目的:观察氯诺昔康对心内直视手术后患者自控镇痛效应的影响。方法:将30例心内直视手术患者随机分为氯诺昔康组和吗啡组,每组各15例。镇痛药为吗啡1mg/mL,参数设置为:负荷剂量1mg,持续输注剂量0.5mg/h,单次给药剂量1mg,锁定时间10min,每4h最大限量20mg。应用PCA泵的同时,氯诺昔康组静脉注射首剂氯诺昔康8mg,首剂药物后12、24和36h,静脉注射氯诺昔康8mg;吗啡组在四时间点均注射生理盐水。镇痛开始后12、24、36和48h记录疼痛VAS评分,PCA需求按压次数和有效按压次数,药物用量,镇静程度评分;术后各种并发症及不良反应发生率;记录镇痛满意度NRS评分。结果:两组患者各时间点安静痛和咳嗽痛评分差异无统计学意义(P>0.05)。镇静程度评分、PCA需求按压次数、有效按压次数及药物用量氯诺昔康组显著低于吗啡组(P<0.05)。两组患者氯诺昔康组恶心发生率显著低于吗啡组(P<0.05),其他术后各种并发症及不良反应发生率差异无统计学意义(P>0.05)。两组患者对镇痛满意度评分、在ICU停留时间及手术后住院时间差异无统计学意义(P>0.05)。结论:氯诺昔康可安全有效地应用于心内直视手术后患者术后镇痛,并减少吗啡用量。

AIM： To observe the effects of lomoxicam on patient controlled analgesia in patients after open heart surgery. METHODS： Thirty patients were randomly allocated to lornoxicam group （n = 15） and morphine group （ n = 15）. Both groups received PCA （patient controlled analgesia ） with morphine （1 mg/mL）. The PCA parameters were morphine loading dose of 1 mg, continuous infusion dose of 0.5 mg/h, single dose of 1 mg, lockout time of 10 min, and 4 hours limit of 20 mg. Lomoxicam group received intravenous lomoxicam of 8 mg while the PCA pump beginning, 12, 24 and 48 h after the first dose. Morphine group received intravenous normal saline at the same four points. The following indexes were recorded at 12, 24, 36 and 48 h after the PCA pumps were used： VAS scores of pain, effective pressing numbers, drug dosage, sedation degree, side effects, and patient satisfaction. RESULTS： There were no significant difference in VAS scores of pain at 12, 24, 36 and 48 hours after the PCA pumps were used（ P 〉 0.05）. The VAS scores of pain, effective pressing numbers and drug dose in lornoxicam group were obviously lower than those in morphine group （ P 〈 0.05）. The incidence rate of nausea in lomoxicam group was obviously lower than that in morphine group （ P 〈 0.05 ）, and there were no significant difference of the other side effects （P 〉 0.05）. There were no significant difference in patient satisfaction degree, residence time in ICU and length of stay after operation （ P 〉 0.05 ）. CONCLUSION： Lomoxicam can relief pain in patients after open heart surgery safely and efficiently, and reduce the morphine consumption.