双氯酚酸钠用于缓解UPPP术后吞咽痛观察

Diclofenac for Relieving the Pain during Swallowing after Adult UPPP

目的：寻找缓解UPPP术后吞咽痛的有效方法。 方法：择期行UPPP患者36例，ASAⅡ-Ⅲ级。随机分为两组．每组18例。全部采用静吸复合全麻，鼻腔插管。术毕患者清醒后拔除气管导管。术后两组PCA用药为：芬太尼（10μg／m1）．含恩丹西酮8mg．总量100ml。预充量4ml，背景速度2ml／hr，PCA量2ml，锁定时间15分钟。A组为单纯PCA组，B组除PCA镇痛外，术后患者吞咽痛时自行用双氯酚酸钠咽部创面喷雾。术后6、12、24、48小时观察安静及吞咽时的疼痛VAS评分．同时记录术后各时间段间PCA按压次数．及恶心呕吐情况。 结果：安静时VAS评分．相同时刻组间比较、组内各时刻比较均无统计学差异（P〉0．05）。吞咽时VAS评分，相同时刻组间比较，B组均小于A组（P〈0．05），组内各时刻比较无统计学差异（P〉0。05）。PCA按压次数．B组按压次数明显少于A组（P〈0．01）。术后恶心呕吐A组较B组多见（P〈0．05）。 结论：芬太尼静脉PCA可适度缓解UPPP术后安静状态时疼痛。但无法解决患者吞咽痛，加用双氯酚酸钠局部喷雾可明显减轻患者吞咽时疼痛。

Objective ： To find a more effective method for post-UPPP pain during swallowing management. Methods ： Thirty-six patients undergoing UPPP were randomized into two postoperative pain management groups, i.v. fentanyl administered via a patient controlled analgesia （PCA） device （fentanyl 10 microgram/ml, total volume 100ml, a loading dose 4ml, a background infusion 2ml/hr, a demand dose 2ml with 15-min intervals） and i.v. fentanyl PCA combined with topical diclofenac （patient spraying diclofenac to the wound by himself when he felt pain during swallowing）. All patients received the standard general anesthesia with nasal intubations. After the operation, the tracheal tube was removed when they regained consciousness completely. Postoperative pain at rest and during swallowing was assessed using pain score [verbal analogue scales （VAS）, 0-10] at 6 h, 12 h, 24 h and 48 h post operation. The static and swallow pain were both recorded. The press number and the incidence of PONV at different time during the observation were also recorded. Results ： The pain scores at rest were not significantly different between the two groups （P〈 0.05） and at the different observing times in any group （P〈 0.05）. At the same observing time, swallowing was significantly less painful in diclofenac group than in fentanyl group （P〈 0.05）. There was no difference on different observing time in the same group considering the pain during swallowing. The press number in diclofenac was significant less than that in fentanyl group （P〈 0.01 ）. The incidence of PONV was higher in fentanyl group （P〈 0.05）. Conclusions ： The PCA with Fentanyl i.v. can relieve postoperative pain after UPPP at rest to some degree, but the pain during swallowing was still severe. Fentanyl via i.v. PCA combined with diclofenac sodium topically on the surgical wound can relieve the swallow pain obviously.