氟比洛芬酯联合芬太尼用于胸腹联合伤患者术后自控静脉镇痛

Clinical Research of Flurbiprofen Axetil Combined with Fentanyl for Patient-controlled Venous Analgesia after Postoperative of Thoracoabdominal Injury

目的观察氟比洛芬酯联合芬太尼用于胸腹联合伤术后患者自控静脉镇痛(Patient-controlled renous analgesia,PCIA)的临床镇痛效果。方法选择胸腹联合伤术后患者84例,随机分为芬太尼组(A组)、氟比洛芬酯组(B组)、氟比洛芬酯联合高剂量芬太尼组(C组)、氟比洛芬酯联合低剂量芬太尼组(D组),每组21例。A组,芬太尼0.5 mg+0.9%NaCl共100 mL;B组,氟比洛芬酯50 mg+0.9%NaCl共100 mL;C组,芬太尼0.5 mg+氟比洛芬酯50 mg+0.9%NaCl共100 mL;D组,芬太尼0.25 mg+氟比洛芬酯50 mg+0.9%NaCl共100 mL。分别观察各组患者术后3、6、12、24 h内的疼痛视觉模拟评分(VAS)、Ramesay镇静评分、自控镇痛(PCIA)按压次数、镇痛满意度及不良反应发生情况。结果 C和D组患者术后各时间点的疼痛VAS、Ramesay评分使用次数略低于A和B组,差异具统计学意义(P<0.05);与C组比较,D组VAS、Ramesay镇静评分无明显差异,但自控镇痛(PCIA)按压次数明显减少(P<0.05)。C组和D组患者恶心、呕吐、嗜睡发生率均低于A组和B组。镇痛满意度C和D组则Ⅰ、Ⅱ级为多,A组和B组以Ⅲ、Ⅳ级居多。结论胸腹联合伤术后患者联合应用氟比洛芬酯和芬太尼的镇痛效果较单独应用阿片类(芬太尼)或非甾体类抗炎药(氟比洛芬醋)要好,同时可明显减少芬太尼的用量和不良反应的发生率,提高患者对治疗的满意度。

Objective To observe the clinical effects of flurbiprofen axetil combined with fentanyl for patient-controlled venous analgesia after postoperative of thoracoabdominal injury. Methods 84 cases were randomly divided into fentanyl group （group A）, flurbiprofen axetil group （group B）, flurbiprofen axetil combined with high-dosage fentanyl group （group C） and flurbiprofen axetil combined with low-dosage fentanyl group （ group D）, with 21 cases in each group. Fentanyl 0. 5 mg in group A, flurbiprofen axeti150 mg in group B, flurbiprofen axeti150 mg and fentanyl 0. 5 mg in group C and flurbiprofen axeti150 mg and fentanyl 0. 5 mg in group D made respectively 100 mL solution plus distilled water. The visual analog scale （VAS）, Ramesay score, times of PCIA and incidence of side effects at 3, 6, 12, 24 h after operation were all recorded, and as well as analgesic satisfaction at the end of the observation. Results The VAS and Ramesay scores of group C and D with each time point were slightly fewer than that of group A and B （ P〈 0. 05）. The incidence of side effects of group C and D were lower than that of the group A and B （P〈 0. 05 or P〈 0. 01 ）. The time of PCIA group C and D was significantly less than group A and group B （ P〈 0. 05）. Compared with group C, there was no statistically significant difference in VAS and Ramesay score and significantly reduced times of PCIA and incidence of side effects in group D. Conclusions Flurbiprofen axetil combined with fentanyl for patient-controUed venous analgesia has a better analgesic effect than separate application opiates （fentanyl） or nonsteroidal anti-inflammatory drug （lurbiprofen axetil） after postoperative of thoracoabdominal injury, and can obviously reduce the dosage of fentanyl and the incidence of side effects, and improve the treatment of patients with satisfaction.