氟比洛芬酯复合小剂量芬太尼用于肝功能不全产妇术后自控镇痛的观察

Clinical observation of postoperative intravenous analgesia with flurbiprofen axetil injection combined with low-dose fentanyl in patients with abnormal liver function for low-segment cesarean section

目的评估氟比洛芬酯复合小剂量芬太尼在肝功能不全产妇术后静脉自控镇痛(PCIA)的效果与不良反应。方法 90例乙型肝炎肝功能不全行子宫下段剖宫产术患者,ASA分级Ⅱ或Ⅲ级,Child-Pugh分级A级,术中应用腰-硬联合麻醉,术后行PCIA,根据不同用药方法随机均分为A、B、C三组。A组:芬太尼1.0mg+生理盐水至100ml;B组:氟比洛芬酯100mg+芬太尼1.0mg+生理盐水至100ml;C组:氟比洛芬酯100mg+芬太尼0.5mg+生理盐水至100ml。分别于术后6、12、24和48h用视觉模拟评分法(VAS)评价镇痛效果;记录24h内PICA按压次数,观察患者恶心、呕吐、嗜睡、呼吸抑制、异常出血等不良反应的发生情况及术前和术后24h肝功能的变化情况。结果三组患者均获得较好的镇痛效果。三组VAS评分及按压次数差异无统计学意义;A、B组恶心、嗜睡等不良反应发生率明显高于C组(P<0.05);镇痛期间三组均未发生异常出血、呼吸抑制等并发症,三组患者术前术后24h肝功能变化差异无统计学意义。结论氟比洛芬酯复合小剂量芬太尼用于肝功能不全产妇术后静脉镇痛效果好,有效减少芬太尼的用量,且降低了不良反应的发生率,对患者肝功能无影响。

Objective To assess analgesic efficacy and adverse reactions of postoperative analgesia with flurbiprofen axetil combined with lowdose fentanyi in patients with abnormal liver function for low- segment cesarean sectiou. Metlmds Ninety patients with ASA class Ⅱ of Ⅲ and Child Pugh class A for low- segment cesarean section were randomly divided into groups A, B, C and 30 cases in each group. For postoperative PCIA, the patients in group A received fentanyl 1.0 rag＋0. 9% NaCI solution to 100 ml, group B, flurbiprofen 100 mg＋fentanyl 1.0 mg＋0. 9% NaCl flution to 100 ml, and group C, flurbiprofen 100 mg ＋fentanyl 0. 5 mg＋0. 9% NaCI flution to 100 ml. The evaluation of VAS score at 6, 12, 24 and 48 h after operation, the number of button-pressing during PCIA and incidence rate of side effects were recorded. Results There were no statistical differences in the VAS score and the number of button-pressing among three groups. The incidences of nausea and vomiting, lethargy in group C were significantly lower than those of in group A and B（P〈0. 05）. There were no complication of abnormal bleeding and respiratory depression. There were no statistical differences in the blood clotting function among three groups. Conclusion Flurbiprofen axetil injection combined with low-dose fentanyl has satisfying analgesia effects and no significant effects on liver function in patients with abnormal liver function for low-segment eesarean.