氟比洛芬酯复合舒芬太尼用于老年患者术后镇痛的效果

Effects of flurbiprofen axefil combined with sufentanil for postoperative analgesia in elderly patients

目的探讨氟比洛芬酯复合舒芬太尼用于老年患者术后镇痛的安全性和有效性，并找出合适的用药方法。方法行择期上腹部手术患者60例，年龄65-85岁，ASAⅠ或Ⅱ级，随机均分为四组。A组：术毕缝皮时静注氟比洛芬酯50mg，术后PCA镇痛液中含舒芬太尼100μg。B组：术后PCA镇痛液中含氟比洛芬酯150mg，舒芬太尼75μg。C组：术毕缝皮时静注氟比洛芬酯50mg，术后PCA镇痛液中含氟比洛芬酯150mg，舒芬太尼50μg。D组：术毕缝皮时不给予氟比洛芬酯，术后PCA镇痛液中含舒芬太尼100Ug。分别记录苏醒后、术后4、8、12、24h VAS评分，Ramsay镇静评分，术后不同时点PCA泵按压次数、实际有效按压次数，术后24h舒芬太尼累积用量以及不良反应，记录苏醒时间、拔管时有无躁动、咽痛。结果与A、C组比较，T0～T2时B、D组VAS评分明显升高（P〈O．05）。与B、C组比较，T1、T2时A、D组Ramsay评分明显升高（P〈0．05）。与A、C组比较，B、D组PCA实际、有效按压次数明显增多（P〈0．05）。与C组比较，术后24h内A、B、D组舒芬太尼用量明显增多（P〈O．05）。结论老年患者行上腹部手术术毕缝皮时静注氟比洛芬酯50mg，术后PCA镇痛液中含氟比洛芬酯1I50mg／ml、舒芬太尼0．50μg／ml，术后镇痛效果好，不良反应少。

Objective To investigate the efficacy and safety of flurbiprofen axefil combined with sufentanil on postoperative pain in elderly patients and to explore the optimizing medication. Methods Sixty patients （ASA Ⅰ Ⅱ ） aged 65-85 yrs undergoing elective upper abdominal surgery were randomly divided into four groups（n = 15 each）. In A group flurbiprofen axefil 50 mg was given intravenausty after the surgery, with sufentanil 100 μg in PCA pump. In B group flurbiprofen axefil 150 mg＋ sufentanil 75μg was added in PCA. In C group flurbiprofen axefil 50 mg was given intravenausty with flurbiprofen axefil 150 mg ＋ sufentanil 50 μg in PCA. In D group sufentanil 100 μg was added in PCA. VAS score, Ramsay sedation score, the cumulative sufentanil consumption, the number of atempts, number of successful deliveries and side-effects were evaluated at 0, 4, 8, 12 and 24 h after the surgery. The awakening time and extubation time was also recorded. Results In B and D groups the VAS score was significantly higher than that in A and C groups at 0, 4, 8h after the surgery （P〈0.05）. In A and D groups Ramsay score was significantly higher than that in B or C group at 4, 8, 12h after the surgery （P〈0.05）. Number of attempts and the number of successful deliveries was significantly higher in B, D groups （P〈0. 05）. The consumption of sufentanil was significantly lower in group C than that in A, B or D group （P〈0. 05）. Conclusion PCIA with flurbiprofen axetil 1.50 mg/ml combined with sufentanil 0.50 μg/ml injection could be a safe and effective method for postoperative analgesia in elderly patients.