氟比洛芬酯对髋关节置换术后镇痛效果及TXA_2和GMP-140含量的影响

The postoperative analgesia of flurbiprofen axetil combined with fentanil and the effect on the expression of TXA2 and GMP-140 in patients with hip replacement surgery

目的探讨氟比洛芬酯对髋关节置换术后镇痛及血栓素A2(TXA2)和血小板颗粒膜蛋白(GMP-140)表达的影响。方法 40例全麻下接受髋关节置换术的患者随机分为两组,氟比洛芬酯镇痛组(FB组)或芬太尼镇痛组(F组),每组20例。于术后1、4、8、12、24和48h采用VAS评分法评价两组患者术后镇痛的效果。采用流式细胞仪检测麻醉前(T0)、手术开始后2h(T1)、术后4h(T2)、24h(T3)、48h(T4)时TXA2和GMP-140的含量。结果与T0时比较,两组T1时、F组T1～T3时TXA2和GMP-140含量明显升高(P<0.05)。与FB组比较,F组T2～T4时TXA2和GMP-140含量明显升高(P<0.05)。术后1、4、8、12、24和48h两组VAS评分差异无统计学意义。术后均未出现胃肠道不良反应和异常出血。结论术后采用氟比洛芬酯镇痛能有效减轻髋关节置换术患者的术后疼痛及抑制TXA2和GMP-140的含量,对降低髋关节置换术患者术后深静脉血栓形成的发生率可能有一定作用。

Objective To explore the effect of postoperative analgesia with flurbiprofen axetil and the effect on platelets activation in patients with hip replacement. Methods Forty patients undergoing hip replacement operation were randamly divided into two groups（n= 20）. Flurbiprofen axetil group（group FB） and Fentanyl alone group （group F） were used for postoperative patient- controlled analgesia（PCA） respectively. The efficiency of analgesia was assessed by visual analogue scale（VAS） at 1,4,8,12,24 and 48 h after operation. The expression of TXA2, GMP-140 and VAS were measured by flow cytometry before anesthesia（T0）, 2 h （T1） after starting operation, 4 h （T2）,24 h （T3） and 48 h （T4） after operation. Results The expression of TXA2 and GMP-140 in both groups at T1 and in group F at T1-T3 FB were increased significantly as compared to the baseline values （P〈0.05）. Compared with group FB, the expression of TXA2 and GMP-140 at T2-T4 after operation was significantly increased in group F （P〈0.05）. There was on difference with VAS scores at 1,4,8,12,24 and 48 h after surgery between the two groups. No gastrointestinal adverse reaction and unusual bleeding happened. Conclusion Flurbiprofen axetil for postoperative PCA can relie~ pain effectively and inhibit the excessive platelet activation of patients receiving hip replacement operation.