氟比洛芬酯联合舒芬太尼用于中老年胸科手术后静脉自控镇痛的可行性

The feasibility of PCIA with combined flurbiprofen axetil and sulfentanyl in adults and aged patients after thoracic surgery

目的评价中老年患者胸科手术后应用氟比洛芬酯联合舒芬太尼静脉自控镇痛(PCIA)的疗效与安全性。方法选择60例ASAⅠ～Ⅱ级择期行开胸手术、并于术后接受PCIA的中老年(年龄≥45岁)患者,随机分为4组。A组:手术切皮前15min、术中关胸后即刻分别给予安慰剂20ml,术后镇痛泵中给予(舒芬太尼100μg+雷莫斯琼0.9mg)/100ml;B组:手术切皮前15min给以安慰剂20ml,术中关胸后即刻给予氟比洛芬酯2mg/kg,术后镇痛泵中给予(舒芬太尼100μg+雷莫斯琼0.9mg)/100ml;C组:手术切皮前15min、术中关胸后即刻分别给予氟比洛芬酯1mg/kg,术后镇痛泵中给予(舒芬太尼100μg+雷莫斯琼0.9mg)/100ml;D组:术中给药方法同C组,术后镇痛泵中给予(舒芬太尼100μg+氟比洛芬酯200mg+雷莫斯琼0.9mg)/100ml。除D组外,其余各组术后镇痛泵药袋中均加入脂肪乳20ml作为安慰剂。各组PCIA泵的设置均为背景量2ml/h,单次负荷量1ml,锁定时间20min。观察各组术后即刻(10h)、4h、8h、24h的疼痛程度及PCIA按压次数、术后镇痛质量、舒芬太尼用量、生命体征、不良反应发生率。各组分别在麻醉诱导前、氟比洛芬酯(或安慰剂)给药后2h、4h、8h、24h采取静脉血行血栓弹力图(TEG)测定凝血功能变化,并记录术前与术后24h肾功能数值。结果 A组、B组术后舒芬太尼总量明显多于D组(P<0.05)。各组不同时点VAS评分比较有显著性差异(P<0.05)。各组镇痛泵的按压次数与有效按压次数无显著性差异(P>0.05)。D组镇痛质量明显优于A组,其余各组间无显著性差异。各组给药前后不同时点血栓弹力图检测结果均无显著性差异。术后呕吐发生率各组间无显著性差异,术后恶心发生率各组间存在显著差异(P<0.05)。结论氟比洛芬酯联合舒芬太尼用于中老年患者胸科手术术后镇痛可提高术后镇痛质量,减少舒芬太尼的用量,降低单纯使用舒芬太尼而产生的不良反应,且不会影响血小板聚集功能,其疗效安全可靠。

Objective To evaluate the effectiveness and safety of Patient-Controlled Intravenous Analgesia（PCIA） in adults and aged patients after thoracic surgery.Methods Totally 60 patients with ASA Ⅰ-Ⅱ were enrolled.They were all older than 45 and underment thoracic surgery, They were randomized into four Groups.20ml placebo solution（Group A） was injected intravenously 15min before the surgery and after the closure of thorax immediately, and then the PCIA （sulfentanyl 100μg＋ramosetron 0.9mg, diluted in NS 100ml） was initiated immediately after the surgery.20ml placebo so-lution and flurbiprofen axetil 2mg/kg （Group B） was injected intravenously before the surgery and immediately after the closure of thorax respectively.The flurbiprofen axetil 1mg/kg （Group C） was administrated intravenously 15min before surgery and immediately at the closure of thorax respectively.The administration of PCIA in both group B and C were the same as Group A.The PCIA （sulfentanyl 100μg＋flurbiprofen 200mg＋ramosetron 0.9mg, diluted in NS 100ml） in Group D was initiated immediately after the end of the surgery.Besides Group D, the fat milk 20ml in other three Groups was mixed into PCIA bag for blinding.The PCIA parameters were set as background infusion 2ml/h, bolus dose 1ml, lockout time 20min.The VAS, patients-pressing-pump parameters, patients satisfaction, vital sign and side effects during PCIA were recorded at 0h, 4h, 8h, 24h after surgery.The total dosage of sufentanyl was also recorded.The venous blood samples were taken before the induction and 2h, 4h, 8h and 24h after the administration of flurbiprofen or the placebo for throm-boelastography （TEG） for coagulation test.The renal function was also recorded 24h after surgery.Results The total dosage of sulfentanyl in Group A and B during PCIA was higer than Group D.There was significant difference in VAS be-tween the four Groups, and the patient satisfaction scale in Group D was much better than in Group A.There was no dif-ference in the press counting of PCIA pumps and the results of TEG among the four Groups.Although there was obviously difference in the incidence of post operative nausea, there was no significant difference in post operative vomiting.Conclu-sions PCIA combined with flurbiprofen axetil and sulfentanyl in adults and aged patients after thoracic surgery can im-prove the effect of analgesia.While the incidence of adverse effects can be reduced by decreasing total dosage of sulfen-tanyl in PCIA pumps.Moreover, it does not affect the function of platelet aggregation so it is safe and effective.