氟比洛芬酯复合舒芬太尼自控静脉镇痛在癌痛治疗中的应用

Patient-controlled intravenous anesthesia of flurbiprofen axetil combined with sufentanil in treatment of cancer pain

目的观察舒芬太尼复合氟比洛芬酯在癌痛患者静脉自控镇痛(PCIA)中的疗效。方法将40例VAS评分中至重度癌痛患者随机分为A、B两组拟行静脉自控镇痛(PCIA)3 d,各20例。A组:舒芬太尼150μg+氟比洛芬酯200 mg+生理盐水至200 ml;B组:舒芬太尼200μg+生理盐水至200 ml,首先给予负荷量舒芬太尼5μg,然后连接镇痛泵进行静脉自控镇痛,持续给药速度2 ml.h-1,单次PCIA 0.5 ml,锁定时间15 min。观察两组患者治疗前和治疗后2、6、12、24、48 h各时间点视觉模拟评分(VAS)、Ramesay法(Rss)镇静评分及不良反应发生率。结果使用重复测量方差分析对A、B两组各评分进行比较。A组VAS评分PCIA前后各个时间点均存在统计学差异(P<0.05),各时间点评分呈下降趋势(P<0.05),Ramsay评分PCIA前后各时间点评分有上升趋势(P<0.001);B组VAS评分PCIA前后各时间点评分呈下降趋势(P<0.05)。相同时间点VAS评分在A、B两组间比较差异不具有统计学意义(P>0.05),Ramsay评分比较A、B两组在PCIA 2,6,12 h 3个时间点差异均有统计学意义(P<0.05),即镇痛效果A组强于B组,且不良反应中,头晕发生率A组明显低于B组,差异有统计学意义(P<0.05)。结论舒芬太尼静脉自控镇痛是治疗癌痛的有效方法;复合氟比洛芬酯可减少舒芬太尼用量,减轻其副作用。

Objective To observe the clinical effects of flurbiprofen axetil combined with sufentanil on PCIA for three days in treatment of cancer pain.Methods Fourty VAS score moderate and severe cancer pain patients who scheduled for PCIA were randomly divided into group A,group B,twenty for each.For group A,sufentanil 0.75 mg·L-1 plus flurbiprofen 1 g·L-1;B group：sufentanil 1 mg·L-1.The loading dose 5 μg was infused before using PCIA,followed by constant infusion at rate of 2 mg·L-1.A dose of 0.5 ml solution would be added when the pain was felt and the lockout time was 15 min.The difference of VAS,Ramesay score and the occurrence of adverse effects were compared between the two groups at each time point of pretreatment and 2,6,12,24,48 hours after treatment.Results In group A,the VAS score showed obvious declining trend according to the time（P0.05）,while the Ramsay score presented an ascending trend（P0.001）.In group B,the VAS score also showed obvious declining trend according to the time（P0.05）.There was no difference in VAS score at any time point（P0.05）.The Ramsay score had obvious difference at 2,6,12 hours three points（P0.05）.There was obvious difference in side effects between group A and B（P0.05）.Conclusion Sufentanil is effective on PCIA for patients of cancer pain,and the mixture of flurbiprofen can decrease sufentanil dose and alleviate adverse effect.