氯诺昔康联合吗啡或曲马多肌注对术后镇痛的影响

Impact of Lornoxicam combination with Morphine versus Tramadol by intramuscular injection on postoperative analgesia

目的观察氯诺昔康联合吗啡或曲马多肌注对术后镇痛的影响。方法选择ASAⅠ～Ⅱ级择期全麻下行妇科剖腹手术的患者36例,随机分为氯诺昔康+吗啡组(LM组)、氯诺昔康+曲马多组(LT组)及对照组(C组),每组12例。手术结束麻醉苏醒前三组分别肌注氯诺昔康8 mg﹢吗啡5 mg、氯诺昔康8 mg﹢曲马多50 mg、等容量的生理盐水。观察术后1、2、4、8、24 h时的视觉模拟评分(VAS)和Ramsay镇静评分,8 h内的PCA有效按压次数及不良反应发生率。结果 LM组和LT组患者术后1、2、4 h的VSA评分明显优于C组(P<0.01),8 h的VSA评分仍优于C组(P<0.05),8 h内PCA按压次数明显少于C组(P<0.01)。LM组术后2 h的Ramsay评分高于C组(P<0.01)和LT组(P<0.05),LT组高于C组(P<0.05)。LM组和LT组术后8 h内恶心发生率均为66.7%、明显高于C组的25%(P<0.01),但LT组呕吐发生率为50%、明显高于C组的16.7%(P<0.01)和LM组的33.3%(P<0.05),均未见呼吸抑制及SpO2下降。结论氯诺昔康联合吗啡或曲马多肌注可有效抑制手术后4 h内的疼痛,减少术后8h内PCA的按压次数及不良反应发生率。

Objective To investigate the impact of Lornoxicam combination with Morphine versus Tramadol by intramuscular injection on postoperative analgesia.Methods Thirty-six ASAⅠ-Ⅱpatients undergoing total or subtotal hysterectomy under general anesthesia were randomly divided into three groups of control（group C） and two intramuscular injection groups of LM（Lornoxicam 8mg combined with Morphine 5mg） and LT（Lornoxicam 8mg combined with Tramadol 50mg） at the end of operation with 12 cases each.Pain intensity was measured by visual analogue scale（VAS） score at 1,2,4,8,and 24h after surgery,and the valid number of pressing PCA pump were recorded at 8h after operation.Meanwhile,the score of Ramsay sedation scale were observed.Results The VAS score of group LM and group LT were significant lower than that of group C at 1,2,4h（P〈0.01）,and at 8h（P〈0.05） after operation.The valid number of pressing PCA pump within 8h after surgery in group LM and group LT were less than that of group C（P〈0.01）.The score of Ramsay scale in group LM was significant higher than that of group C（P〈0.01） and group LT（P〈0.05） within 2h after surgery.Nausea and vomiting were higher in group LT（66.7%,P〈0.01,and 50%,P〈0.01） and group LM（66.7%,P〈0.01,and 33.3%,P〈0.05） than in group C（25% and 16.7%）.No respiration depression and SpO2 decline was observed.Conclusion Lornoxicam combination with Morphine or Tramadol by intramuscular injection can effectively relieve pain within 4h after operation,and reduce the valid number of pressing PCA pump and the incidence of adverse effects within 8h after surgery.