妇科手术术后镇痛中氯诺昔康对曲马多用量及镇痛效果的影响

Tramal-sparing effect and safety of Lornoxicam for postoperative analgesia following gynecological surgery

目的:评价妇科手术术后镇痛中氯诺昔康对曲马多用量的节俭作用和安全性。方法:择期硬膜外阻滞下妇科手术病人60例,22～65岁,美国麻醉医师协会(American society of Anesthesiologists,ASA)Ⅰ或Ⅱ级,随机分为氯诺昔康组和对照组(n=30)。手术结束时给与病人静脉自控镇痛(Patient controlled introvenous analgesid,PCIA),氯诺昔康组的药物配方为0.04%氯诺昔康+0.75%曲马多,对照组为1%曲马多。观察术后曲马多的用量、术后2、4、6、12和24 h的疼痛强度视觉模拟(Visual aualoguescale,VAS)评分、PCIA有效次数、不良反应和病人对镇痛的满意度以及给药前后的凝血功能。结果:与对照组相比,氯诺昔康组术后12 h和24 h曲马多用量减少(P<0.01),术后12 h和24 h PCIA有效次数减少(P<0.05),术后6、12 h和24 h VAS评分降低(P<0.05),术后24 h满意度提高(P<0.01),恶心呕吐的不良反应减少(P<0.05),凝血功能指标无差异(P>0.05)。结论:妇科手术后给予氯诺昔康联合曲马多镇痛可减少曲马多用量,减少不良反应的发生,提高镇痛质量。

Objective： To evaluate the Tramal-sparing effect and safety of Lornoxicam for pain relief following gynecological surgery.Methods： 60 ASA ⅠorⅡpatients aged 22～65 yr undergoing gynecological surgery under epidural anesthesia were randomly allocated to two groups： Lornoxicam group and control group（n=30）.The PCIA pump was set up afer surgery,with 0.04%Lornoxicam＋0.75%Tramal for Lornoxicam group and 1%Tramal for control group.The intensity of analgesia,adverse effects and blood clotting function were recorded and compared between the two groups. Results： The Tramal consumption and the number of successfully delivered doses at 12 and 24 h after operation were significantly less in Lornoxicam group than in control group. The VAS scores at 6,12 and 24 h after operation were significantly lower, and The patients＇ global evaluation of the postoperative analgesia was better in Lornoxicam group. The adverse effects of nausea and vomiting were significantly less in Lornoxicam group Compared with these in control group,There was no difference in blood clotting function between the two groups. Conclusion：Combination of Lornoxicam and Tramal in postoperative analgesia following gynecological surgery may reduce the Tramal consumption and the adverse effects, accordingly elevate analgesia quality.