地塞米松联合氟比洛芬酯对吗啡硬膜外镇痛的影响

Effect of dexamethasone combined with flurbiprofen axeteil on epidural analgesia of morphine

目的探讨地塞米松联合氟比洛芬酯对吗啡硬膜外镇痛的影响。方法择期妇科子宫全切患者60例,每组20例,按随机双盲分成吗啡2.0 mg和氟哌利多2.5 mg硬膜外注入组(Ⅰ组);在Ⅰ组的基础上联合氟比洛芬酯100 mg静脉注入组(Ⅱ组);在Ⅰ组基础上联合氟比洛芬酯100 mg和地塞米松10 mg静脉注入组(Ⅲ组)。手术结束前15 min按组别分别给予术后镇痛药物,观察术后4个时间点(122、4、48、72 h)的视觉模糊评分(VAS评分)、Ramsay镇静评分及恶心、呕吐等不良反应的发生率。结果术后的4个时间点,Ⅲ组VAS评分均低于Ⅰ组和Ⅱ组(P<0.05)。术后24 h,Ⅰ组Ramsay镇静评分低于Ⅱ组、Ⅲ组(P<0.05),在48 h时Ⅱ组低于Ⅲ组(P<0.05);恶心、呕吐发生率Ⅲ组低于Ⅰ组和Ⅱ组(P<0.05),追加镇痛药及止吐药的例数也少于Ⅰ组和Ⅱ组(P<0.05)。结论地塞米松联合氟比洛芬酯可以协同吗啡硬膜外镇痛,延长镇痛时间,不良反应少,是一种良好的术后镇痛方法。

Objective To investigate the effect of dexamethasone combined with flurbiprofen axeteil on epidural analgesia of morphine. Methods Sixty patients undergoing selective gynecological operation were randomly double-blind into 3 groups （ n = 20） ： morphine 2. 0 mg and droperidol 2.5 mg in epidural analgesia （ Ⅰ ） ; morphine 2. 0 mg and droperidol 2.5 mg in epidural analgesia combined with flurbiprofen axeteil 100 mg intravenous injection （ Ⅱ ） ; morphine 2. 0 mg and droperidol 2.5 mg in epidural analgesia combined with flurbiprofen axeteil 100 mg and dexamethasone 10 mg intravenous injection （Ⅲ ）. All of the drugs in operation end 15 minutes before one-time giving. Visual analgesia scale（VAS） , Ramsay scale and side effects were recorded at 12 h ,24 h ,48 h and 72 h after operation. Results VAS in group m was lower than that in group Ⅰ and Ⅱ at each time point （ P 〈 0. 05 ） after the surgery ; Ramsay scale at 24 h in group was lower than that in group Ⅱ and group m （P 〈 0. 05 ） ; Ramsay scale at 48 h in group Ⅱ was lower than in group m （ P 〈 0. 05 ） ; Nausea and vomiting rate were lower in group m than that in group Ⅰ and group Ⅱ （P 〈 0. 05）, and analgesics and antiemetics addi-tional number of cases were less than that in group and Ⅱ （P 〈 0.05）. Conclusion Dexamethasone combined with flurbiprofen axeteil may have synergistic effect on single morphine epidural analgesia, extend analgesia time, reduce the adverse effects, and is a good method of postoperative analgesia.