围术期应用氟比洛芬酯对舒芬太尼用于妇科肿瘤术后镇痛的影响

The effects of analgesia with flurbiprofen axeyil injection combined with sufentanil in perioperative period of patients with gynecological carcinoma

目的观察围术期应用凯纷(氟比洛芬酯)对舒芬太尼用于妇科肿瘤手术后静脉自控镇痛(PCIA)的镇痛效果及安全性。方法选取妇科肿瘤择期手术患者(美国麻醉医师协会术前体格评估Ⅰ～Ⅲ级)90例,随机分成3组。A组30例,术前10分钟静注凯纷1 mg/kg,术后给予凯纷50mg+舒芬太尼1.5μg/kg加生理盐水至100 ml;B、C两组术前均不给凯纷,B组术后给予舒芬太尼1.5μg/kg加生理盐水至100 ml;C组术后给予舒芬太尼2μg/kg加生理盐水至100 ml。背景剂量2ml/h,冲击剂量2 ml,锁定时间15 min。手术结束前10 min给予首次剂量舒芬太尼5μg+欧贝8 mg,手术结束时接泵。观察术后1、4、12、24、48 h的视觉模拟疼痛评分,舒芬太尼总用量、PCIA使用次数及不良反应的发生情况。结果3组患者术后均未发生呼吸、循环系统严重并发症,组间无显著差异(P>0.05);术后视觉模拟疼痛评分(VAS)、PCIA使用次数,B组明显高于A、C组(P<0.05)。C组患者术后恶心、呕吐、头晕、头痛等的发生率明显高于A、B组(P<0.01)。结论围术期应用凯纷可明显增强舒芬太尼用于妇科肿瘤手术PCIA中的镇痛效果,并减少舒芬太尼的总药量和术后不良反应。

Objective To study the effects of postoperative analgesia and safety with flurbiprofen axeyil injection combined with sufentanil in patients undergoing gynecological carcinoma. Methods 90 cases of ASA （ American Society of Anesthesiologists） Ⅰ - Ⅲ level patients who received patient-courolled in- travenous analgesia （PCIA） , scheduled for gynecological carcinoma were randomly divided into three groups equally. Group A was administrated injection flurbiprofen axeyil 1 mg/kg before the operation and injection another flurbiprofen axeyil 50 mg at the end of operation, then with sufentanil 1.5 μg/kg, group B with sufentanil 1.5μg/kg and group C with sufentanil 2.0μg/kg. The drugs in both groups were diluted to 100 ml and infused by a pump at a rate of 2 ml/h with a patient-controlled bolus of 2 ml, and locked-time of 15 minutes. Injection of sufentanil 5 μg puls ondansetron 8 mg was conducted at 10 minutes to the end of op- eration. The visual analog scale （VAS）, times of PCIA and incidence of side effects were recorded at 1 h, 4h,12h,24h,48h after operation. Results There was no significant difference in the three groups in surgery duration（P 〉 0. 05 ）. VAS B 〉 VSA A, C ; The times of the PCIA 24 hr after operation in group B were sig- nificantly more than group A and C（P 〈0. 05）. The accidences of nausea, vomiting, itching, somnolence in group C were significantly more than in group A and B （ P 〈 0. O1 ）. Conclusion Postoperative analgesia with flurbiprofen axeyil injection combined with snfentanil can reduce sufentanil requirement and its side effects.