氟比洛芬酯联合舒芬太尼用于脊柱手术后静脉自控镇痛

Patient-controlled intravenous analgesia(PCIA)with flurbiprofen combined sufentanyl in spinal operation

目的研究氟比洛芬酯联合舒芬太尼用于脊柱手术后静脉自控镇痛(PCIA)的临床效果和安全性。方法择期全麻下行脊柱手术患者90例,随机分为3组,每组30例,术后均行PCIA,A组:舒芬太尼2μg.kg-1;B组:舒芬太尼1.5μg.kg-1;C组:舒芬太尼1.5μg.kg-1+氟比洛芬酯2mg.kg-1。三组均加入恩丹西酮8mg,用0.9%氯化钠稀释至100mL。PCIA持续剂量2.0mL.h-1,追加剂量1.0mL,锁定时间15min。术后2、6、12、24、48h双盲对照观察各组视觉模拟评分(VAS),镇静评分(Ramsay)、满意度评分和镇痛泵按压情况以及不良反应发生情况。结果 A组和C组各时点镇痛评分无统计学差异、平均值都小于3分,均小于B组(P<0.05);A组和C组镇痛满意度高、镇痛泵按压次数少且有效按压率高,与B组比较有统计学差异(P<0.05)。A组术后2、61、2h Ramsay评分较高、呼吸抑制、恶心呕吐等不良反应的发生率高于B组和C组(P<0.05)。结论氟比洛芬酯联合舒芬太尼用于脊柱患者手术后PCIA,镇痛效果好并可减少单纯用舒芬太尼的剂量,安全可靠,不良反应少,为理想的镇痛方法。

OBJECTIVE To observe the analgesic efficacy,safety and side effect of postoperative patients-controlled intravenous analgesia with flurbiprofen combined sufentanyl in spinal operation.METHODS Ninety ASA III patients aged 21～59 yrs weighing 46～81kg underwent spinal operation under general anesthesia were randomly divided into three gorups（n=30 each）.Sulfentanyl was used with PCIA in each group.Group A received sulfentanyl 2.0μg·kg-1;Group B received sulfentanyl 1.5μg·kg-1;Group C received sulfentanyl 1.5μg·kg-1＋ flurbiprofen 2.0mg·kg-1.PCA pump（100mL）was setup with background infusion at 2.0mL·h-1 and a bolus dose of 1.0mL（lockout interval 15min）.Pain score and drug sedative score were assessed at 2,6,12,24 and 48 hrs after analgesia.Respiratory depression,nausea,vomiting and pruritus were recorded.RESULTS Both average VAS in group A,C3 and the effect of analgesia in the two groups has no difference but has significant difference between group B（P0.05）.The Ramasy scores were significantly higher in group A than in group B,C（P0.05）.Respiratory depression,nausea and vomiting in group A were significantly higher than in group B,C（P0.05）.CONCLUSION PCIA with flurbiprofen combined sufentanyl provide the optimum balance between pain relief and side effects in spinal operation.