不同时间点应用氟比洛芬酯对开胸术后镇痛效果的影响

Analgesic effect of flurbiprofen axetil used at different time points after thoracic surgery

目的观察不同时间点使用氟比洛芬酯对开胸术后患者镇痛效果的影响。方法行开胸手术的患者113例,根据用药时间点的不同分为:组1,32例,为对照组;组2,43例,全麻诱导前静脉注射氟比洛芬酯50mg;组3,38例,关胸时静脉注射氟比洛芬酯50mg。3组均行静脉全身麻醉。术毕缝皮时3组开启同样配方的患者静脉自控镇痛(PCIA)泵(AutoMed 3300,韩国),2mL/h,内含芬太尼1mg、氟比洛芬酯200mg、昂丹司琼8mg,稀释至100mL。术后患者根据疼痛视觉模拟评分(VAS评分)自行调控镇痛泵,静息时VAS评分≥4分另行镇痛处理。活动后VAS评分≥4分启动自控按钮给予一次补救剂量的镇痛药(单次自控剂量为0.5mL,锁定时间为15min)。在术毕患者清醒后拔除气管导管即刻(T1)及术后24h(T2)、48h(T3)静息时对患者行疼痛VAS评分。并记录术毕～术后24h、术后24～48h患者的PCIA泵按压次数。结果组2、组3在T1、T2时间点的VAS评分及术毕～术后24h、术后24～48h患者的PCIA泵按压次数显著低于组1(P值均<0.05);组2在T1、T2时间点的VAS评分及术毕～术后24h、术后24～48h患者的PCIA泵按压次数显著低于组3(P值均<0.05)。结论氟比洛芬酯有较强的镇痛作用,麻醉诱导前静脉注射及术后静脉维持联合使用能发挥最佳的镇痛效果。

Objective To observe the analgesic effect of flurbiprofen axetil used at different time points in patients undergoing thoracic surgery. Methods Totally 113 thoracic patients undergoing surgery under general anesthesia were divided into three groups, group 1 （ n = 32） was control group group 2 （ n = 43） was given 50 mg flurbiprofen axetil intravenously prior to the induction of general anesthesia and group 3 （n=38） was injected intravenously with 50 mg flurbiprofen axetil on closure of the chest. All the three groups received the same patientcontrolled intravenous analgesia（PCIA, containing fentanyl 1 mg, flurbiprofen axetil 200 mg, ondansetron 8 mg, diluted to 100 mL, 2 mL/h） at the end of surgery. Resting hours under the visual analog scale （VAS） score≥4 divided the analgesic treatment. The VAS score≥4 after movement gave a remedial dose of painkillers（single dose 0.5 mL/time, lockout time 15 min）. VAS pain score was recorded at the time of extubation （T1） and 24 h （T2）, 48 h （T3） of the resting hours after the surgery. The times of PCIA button press were recorded at the end of operation to 24 h and 24 to 48 h after surgery. Results Compared to group 1, the times of POIA button press at the end of operation to 24 h and 24 to 48 h after the surgery were less in group 2 and 3 （all P〈0.05）. VAS scores of group 2 and 3 were also lower than those of group 1 at T1 and T2 （all P〈0.05）, and those of the group 2 was significantly lower than those of the group 3 （both P〈0.05）. Conclusion Flurbiprofen axetil has potent analgesic effect the best timing might be before induction combined with post-operation use.