氟比洛芬酯 芬太尼用于腰椎管狭窄镇痛研究

Clinical Observation of Patient Controlled Intravenous Flurbiprofen Axeyil Injection Combined with Small Dose of Fentanyl for Postoperative Analgesia on Patient of Lumbar Spinal Canal Stenosis

目的研究氟比洛芬酯复合小剂量芬太尼与单纯芬太尼和单纯氟比洛芬酯用于腰椎管狭窄扩大成形椎弓钉内固定手术后静脉镇痛的临床效应。方法腰椎管狭窄手术的患者45例,随机分为3组,泵内药物:A组,芬太尼1mg+格拉司琼3mg+0.9%NaC1共100ml;B组,氟比洛芬酯200mg+格拉司琼3mg+0.9%NaC1共100ml;C组,氟比洛芬酯100mg+芬太尼0.5mg+格拉司琼3mg+0.9%NaC1共100ml。参数设定:A组负荷量为泵内药物5ml,B、C组负荷量为氟比洛芬酯50mg(5ml),持续输注为各组泵内药物2ml/h,PCA2ml,锁定30min。观察24h内的镇痛评分(VAS),PCA使用次数及不良反应的发生情况。结果术后24h时A,B和C组的VAS,3组间差异无显著性(P>0.05)。24h内的PCA按压次数c组显著少于A和B组(P<0.05)。B,C组不良反应的发生率显著低于A组(P<0.05)。镇痛期间无异常出血等并发症发生。结论氟比洛芬酯复合小剂量芬太尼用于腰椎管狭窄手术后静脉镇痛效果良好,可明显减少芬太尼和氟比洛芬酯的用量及不良反应的发生率。

Objective To compare postoperative analgesic efficacy between intravenous flurbiprofen axeyil injection combined with a small dose of fentanyl and fentanyl alone and flurbiprofen alone for vcrtebroplasty on patient of lumbar spinal canal stenosis by internal fixation with pedicle screw system of vertebral arch nail. Methods Forty five patients undergoing lumbar spinal canal stenosis were randomly divided into three groups with 15 cases in each group. The drugs in infusion pumps is Fentanyl ling was used in group A,Flurbiprofen axeyil injection 200 mg was used in group B and Flurbiprofen axeyil injection 100mg plus fentanyl 0. 5mg was used in group C. The drugs combined with Granisetron 3mg in each group were diluted to 100ml with 0. 9 sodium chloride and infused by a pump at a rate of 2ml/h with a patient -controlled analgesia （PCA） bolus of 2ml/30min after a loading dose of 5ml. The loading dose of group A is the drugs in infusion pumps, group B and C is Flurbiprofen axeyil injection 50mg. The visual analog scale （VAS） ,times of PCA and incidence of side effects were recorded during the period 24 hours after operation. Results Twenty hours after operation the VAS of the three groups became similar in all （ all P 〉 0. 05 ）. The demanding times for supplemental bolus in the group C were significantly less than those in the group A and B （ all P 〈 0. 05） . The incidences of nausea, vomiting, skin pruritus, dizziness ,somnolence and respiratory depression in group B and C were significantly less than those in group A （allP 〈 0. 05）. No abnormal bleeding occurred in the three groups. Conclusion Intravenous postoperative analgesia with flurbiprofen axeyil injection combined with small dose of fentanyl on patient of lumbar spinal canal stenosis has a better analgesic effect than fentanylalone and flurbiprofen alone ;the new strategy can reduce fentanyl and flurbiprofen usage and its side effects.