氯诺昔康复合吗啡镇痛对肺切除患者术后呼吸功能的影响

Effects of analgesia with lornoxicam combined morphine on respiratory function in patients after pulmonary lobectomy

目的观察氯诺昔康复合吗啡自控镇痛(PCA)对肺叶切除术患者呼吸功能的影响。方法 40例肺叶切除术患者随机分为氯诺昔康组(L组)和吗啡组(M组),每组20例。PCA泵的镇痛药为吗啡1 mg/ml;同时,L组于术毕和术后12、243、6 h静脉注射氯诺昔康,每次8 mg;M组在相应时点注射生理盐水,记录镇痛12、24、36和48 h VAS评分及镇静程度评分;PCA需求按压次数、有效按压次数及药物用量;术后各种并发症及不良反应发生率;术后24、48和72 h呼吸功能指标。结果两组患者各时点安静痛和咳嗽痛VAS评分差异无统计学意义;镇静程度评分、PCA需求按压次数、有效按压次数及药物用量L组显著低于M组(P<0.05);L组恶心发生率显著低于M组(P<0.05);L组术后244、8 h的用力肺活量(FVC)、第1秒用力肺活量(FEV1)和FEV1/FVC明显高于M组(P<0.05),PaCO2明显低于M组(P<0.05)。结论氯诺昔康用于肺叶切除术患者PCA可减少吗啡用量,并有利于呼吸功能恢复。

Objective To investigate effects of analgesia with lornoxicam combined morphine on patient controlled analgesia（PCA） and pulmonary function in patients after pulmonary lobectomy. Methods Forty patients were randomly allocated to two groups of lornoxicam （group L） and morphine（group M） with 20 cases each. Both groups received PCA with morphine 1 mg/ml. Group L was given intravenous lornoxicam 8 mg at 0, 12, 24 and 48 h during analgesia. VAS pain score, sedation score, demanded delivery, effective delivery, drug dose, and side effects were recorded at 12, 24,36 and 48 hours during analgesia. The parameters of pulmonary function were measured at 24,48 and 72 h after operation as well. Results There were no significant difference in VAS pain scores during analgesia between two groups. Sedation score, demanded delivery, effective delivery and drug dose were obviously lower in group L than those in group M（P〈0. 05）. The incidence rate of nausea in group L was obviously lower than that in group M（P〈0.05）. FVC, FEV1 and FEV1/FVC at 24 and 48 h after operation were significantly higher in group L than those in group M（P〈0. 05）. PaCO2 at 24 and 48 h after operation was significantly lower in group L than that in group M（P〈0.05）. Conclusion Lornoxicam can reduce morphine consumption and improve respiratory function during PCA with morphine in the patients after pulmonary lobectomy.