氟比洛芬酯联合术后硬膜外PCA的预防性镇痛效应

Preventive analgesia effects of flurbiprofen combined with postoperative epidural patient controlled analgesia

目的研究切皮前、后静脉注射氟比洛芬酯对布托啡诺复合左旋布比卡因术后硬膜外镇痛效应的影响。方法选择硬膜外麻醉行择期腹式全子宫切除术患者60例，随机分成3组，F1组（n=20）切皮前15～20min静脉注射氟比洛芬酯2mg／kg，F2组（n=20）切皮后15min静脉注射氟比洛芬酯2mg／kg，F0组（n=20）未用氟比洛芬酯（对照）。3组术后均实施硬膜外患者自控镇痛（PCA）24h，镇痛配方为0．2％左旋布比卡因和0．06％布托啡诺混合液。记录术后视觉模拟评分（VAS）、Ramesay镇静评分、PCA泵的按压次数（D1）与实际进入次数（D2）、各时段总入药量、肛门排气时间、术后7d镇痛药的使用情况与不良反应。结果3组患者PCA期间VAS、Ramesay镇静评分，D1和D2值在T0、T1时间段内基本相似（P〉0．05）。F0组T2、T3时间段D1、D2值较F1、F2组增高，F0组T2、T3时段PCA入量最多（P〈0．05），而F1组、F2组间无差别（P〉0．05），3组D1和D2值在T2、T3时段均明显高于T0、T1时段（P〈0．05），以F0组最突出（P〈0．05），PCA期间F0组有3例（15％），F1组、F2组各有1例（5％）VAS〉5，并需要额外在硬膜外追加吗啡镇痛。手术后第2d，F2组有1例（5％），F0组2例（10％）需要肌内注射镇痛药物缓解术后疼痛。3组患者恶心、呕吐发生率为15．0％～25．0％；术后肛门恢复排气的时间F1、F2组明显短于F0组（P〈0．05）。结论切皮前给予患者靶向非甾体类镇痛药氟比洛芬酯2mg／kg较切皮后给药，能增强并延长布托啡诺复合左旋布比卡因硬膜外PCA镇痛效应，达到预防性镇痛目的。

Objective To evaluate the preventive analgesia effects of flurbiprofen combined with postoperative epidural patient controlled analgesia. Methods Sixty patients undergoing abdominal total hysterectomy were randomly divided into 3 groups （n= 20 each）： group F1 , group F2 and group F0. In group F1 flurbiprofen was adminstered 2mg/kg intravenously 15-20 min pre-incision; group F2 flurbiprofen 2 mg/kg was given 15 rain after incision; group F0 ： no flurbiprofen was given. All the patients in the 3 groups received postoperative epidural patient controlled analgesia. The mix ture formula was 0. 2% levobupivacaine and 0. 06% butorpbanol. Visual analogue scales （VAS） and Ramesay sedation scale were quantified respectively after PCA pump started. The ratio of the demand （D1） and delivery（D2 ）, PCA comsumption, the recovery time of bowel motility, dosage of analgesic agent after surgery, adverse effects and its treatment were also recorded. Results There were no obvious differences in VAS, Ramesay sedation scale,ratio of D1 and D2 at T0 , T1 among 3 groups （P〉0.05）. D1 and D2 of group F0 at T2 and T3 were higher than those of group F1 and group F2. PCA consumption in group F0 was more than that in other two groups at T2, T3. There were no significant differences of PCA consumption between group F1 and group F2. D1 and D2 of three groups at T2,T3 were markly more than T0 and T1 （P〈0. 05）, group F0 ranked the first among groups （P〈0. 05）. 3 patients （15%） in group F0, 1 patient in group F1 and group F2 respectively needed additional epidural morphine to relieve pain during PCA period. 2 days after the surgery, 1 patient （5 %）in group F2 and 2 （10 % ）in group F0 required analgesic intramuscular to relieve pain. 15.0 - 25.0% patients among 3 groups showed nausea and vomiting. The patients in group F1 and F2 recovered their bowel motility earlier. Conclusion Premedication with flubiprofen 2 mg/kg before the incision of operation can prolong and enhance the PCA effects of combination of butorphanol and levobupivaeaine.