氟比洛芬酯复合小剂量吗啡用于胸科术后静脉镇痛的临床观察

Observation for flurbiprofen axetil combined with low dose morphine using on intravenous postoperative analgesia after thoracic surgery

目的观察氟比洛芬酯复合小剂量吗啡用于开胸手术术后静脉镇痛的效果和安全性。方法60例开胸手术患者,随机分成两组(F、M组),每组30例,术毕接电子泵行静脉自控镇痛(PCIA)。F组手术结束前15min静脉注射氟比洛芬酯50mg+吗啡3mg为首量,维持配方为吗啡24mg+氟比洛芬酯300mg+生理盐水共150ml,背景流量2ml/hr,单次剂量3ml,锁定时间30min。M组在相同时间点给吗啡3mg为首量,维持配方为吗啡60mg+生理盐水共150ml,参数同F组。分别记录和统计手术后12、48h各时间点两组患者的视觉模拟疼痛评分(VAS)、镇静评分(Ramsay评分)、泵按压次数、伤口引流量及恶心、呕吐、瘙痒、呼吸抑制、消化道出血等不良反应的发生率。结果两组镇痛效果相近,VAS评分和48h伤口引流量组间比较,差异无统计学意义(P>0.05),F组镇静评分、恶心、呕吐、瘙痒发生率低于M组,组间比较,差异有统计学意义(P<0.05)。M组有1例呼吸抑制,F组无呼吸抑制。两组均未见消化道出血。结论氟比洛芬酯复合小剂量吗啡用于开胸手术术后静脉镇痛,疗效确切,不良反应少,安全性高。

Objective To investigate the efficacy and safety of intravenous analgesia with flurbiprofen axetil combined with low dose of morphine after thoracic surgery. Methods Sixty patients were randomly divid- ed into two groups （F and M） with 30 cases each. Patient - controlled intravenous analgesia （PCIA） was ap- plied after surgery in both group. Group F： morphine 3 mg ＋ flurbiprofen axeti150 mg was given as the loading dose with the maintenance of morphine 24 mg ＋ flurbiprofen axetil 300mg ＋ O. 9% Sodium chloride diluted to 150 ml . Group M ： morphine 3 mg as the loading dose with the maintenance of morphine 60 mg ＋ 0.9% Sodium chloride diluted to 150 ml. Both loading dose were given intravenously 15 minutes before the end of operation and continuous infusion rate was 2 ml/h and bolus was 3ml each time and lock time was 30 minutes. The effica- cy of analgesia was assessed by visual analogue pain score （VAS）, sedation score （Ramsay score）, the number of pumps pressing , wound drainage and the side effects such as nausea, vomiting, pruritus, respiratory depres- sion, gastrointestinal bleeding during the period of postoperative 12 hours and 48 hours. Results The analgesic effects were similar and the VAS score and 48 hours wound drainage showed no statistical difference （ P 〉 0. 05）. In Group F , the sedation score and the incidence rate of nausea, vomiting, pruritus were lower than those in group M and the differences were statistically significant（ P 〈 0. 05 ）. One case of respiratory depression occurred in group M and no respiratory depression was found in F Group. No gastrointestinal bleeding occurred in either of the two groups. Conclusion After thorax surgery, intravenous postoperative analgesia with flurbi- profen axetil combined with low dose of morphine is effective with less side effects and more safeness.