氯诺昔康超前镇痛对腹腔镜胆囊切除术后镇痛的影响

Efficacy of Lornoxicam for Preemptive Analgesia after Laparoscopic Cholecystectomy

目的探讨氯诺昔康超前镇痛对腹腔镜下胆囊切除患者术后镇痛的影响。方法选择腹腔镜下胆囊切除术患者80例,随机分为氯诺昔康超前镇痛组(A组)和氯诺昔康术后镇痛组(B组),每组40例。所有患者均采用静脉全身麻醉:芬太尼、维库溴铵复合异丙酚血浆靶控输注。两组患者分别在麻醉诱导前10分钟和手术结束时静注氯诺昔康0.2mg/kg,术毕拔管清醒后均采用芬太尼0.5μg/kg用于术后镇痛。采用VAS评分法评估患者术后0、1、2、4、8、12、24小时疼痛程度并记录需追加芬太尼镇痛患者的时间间隔及追加次数;记录手术时间、麻醉苏醒时间及不良反应等情况。结果A组患者在术后0、1、2、4、8、12、24小时VAS评分均低于B组(P<0.05),且术后24小时内需追加芬太尼镇痛的患者明显少于B组(0:22.7%;P<0.05)。两组患者手术时间、麻醉苏醒时间及不良反应发生率差异无统计学意义(P>0.05)。结论氯诺昔康0.2mg/kg超前镇痛可以产生较好的术后镇痛效果,同时可减少阿片类药物的应用。

Objective To evaluate effects of lornoxieam for preemptive analgesia in patients undergoing laparoseopie choleeystectorny （LC）. Methods Eighty patients undergoing LC were randomly divided into two groups： A and B. Patients in Group A （n=40） received lornoxieam（i, v. 0.2mg/kg） 10 minutes before induction; patients in Group B （n=40） received the same doses lornoxicam （i. v. 0.2mg/kg） after skin closure. A standardized general anesthetic was used. All patients were started on fentanil（i, v. 0.5μg/kg） analgesia when awake after tracheal extubation. The effectiveness was assessed postoperatively using the visual analogue scale （VAS） at 0.1.2.4.8.12.24 hours after surgery, and by calculating the to tal analgesic consumption of fentanil in the first 24 hours following operation. Time to first analgesic request, vital signs and side effects were also recorded. Results Patients in group A reported significantly lower pain scores （P〈0.05） at all time intervals compared to group B. There were significantly fewer patients in the preemptive group than comparative group who required rescue analgesic within the first 24 hours （0 vs 22.6%; P〈0.05）. Mean time to first analgesic request was also significantly longer in the preemptive group（P〈0. 05）. Conclusion Lornoxicam administered preemptively appears to improve the quality of postoperative analgesia and lead to reduced consumption of opioid analgesics postoperatively in patients undergoing LC.