非甾体类抗炎药在胸腔镜辅助肺叶切除术后多模式镇痛中的应用

Application of non-steroidal anti-inflammatory drugs in multimodal analgesia after VATS lobectomy

目的 观察非甾体类抗炎药对胸腔镜辅助肺叶切除术后患者多模式镇痛效果的影响和安全性.方法 60例ASA Ⅰ～Ⅱ级拟行胸腔镜辅助肺叶切除术患者,随机均分为P、F、C组各20例.P组在切皮前和术后24h分别静注40 mg帕瑞昔布钠;F组在切皮前静注氟比洛芬酯50 mg,并于PCIA泵中加入200 mg氟比洛芬酯;C组在切皮前和术后24 h分别静注生理盐水5 mL;关胸前行肋间神经阻滞,术毕患者清醒拔除气管导管后接PCIA泵.观察PCIA泵开启后2 h（T1）、4h（T2）、8 h（T3）、12 h（T4）、24 h（T5）、48 h（T6）、72 h（T7）时静息、咳嗽视觉模拟评分（VAS）,并记录PCIA泵的有效按压次数;记录T6、T7时患者对镇痛效果的评价,记录呼吸监测指标及不良反应.结果 与C组相比,T1、T2时PClA泵实际按压次数3组间无统计学性差异;T3～T6时P组和F组PCIA泵实际按压次数明显减少（P均＜0.05）,P组和F组间无统计学差异.静息及咳嗽VAS在T1、T2时点3组间无统计学差异,在T3～T6各时点P组及F组明显低于C组（P均＜0.05）,P组和F组间无统计学差异;在T7时点3组间均有统计学差异（P均＜0.05）.各时点呼吸监测指标组间无统计学差异,P组及F组对镇痛效果的评价明显高于C组（P均＜0.05）;各组均未观测到严重不良反应.结论 非甾体类抗炎药用于胸腔镜辅助肺叶切除术后多模式镇痛可增强镇痛效果,且不增加不良反应;对患者呼吸影响小,有利于患者排痰.

Objective To observe the analgesic efficacy and safety of non-steroidal anti-inflammatory drugs in multi- modal analgesia after video-assisted thoracic surgery （VATS） lobectomy. Methods Sixty ASA I-II patients undergoing VATS lobectomy were included in the study. They were randomly divided into 3 groups ： group P, group F and group C （ n = 20）. Patients in group P received 40 mg parecoxib sodium before skin incision and the same dose 24 hours after surgery. Patients in group F received 50mg flurbiprofen axetil before skin incision and 200 mg flurbiprofen axetil was added to PCIA. Patients in group C received 5mL normal saline before skin incision and the same dose 24 hours after surgery. All patients were administered an intercostal nerve block before chest closure and connected to PCIA pump after extubation. The visual analogue scale （VAS） at rest and coughing and the effective button-pressing times in PCIA were recorded at 2 h （T1）, 4 h （T2）, 8 h （3＂3）, 12 h （T4）, 24 h （TS）, 48 h （T6） and72 h （T7） after the start of PCIA. Patients＇ evaluation of an- algesic efficacy was recorded at time T6 and T7. Respiratory monitoring parameters （RR, SpO2 ,＇ PETCO2 ） , vital sign and side effects were also recorded. Results At time T1 and T2, three groups showed no significant difference in the effective press times of PCIA ; the effective press times of PCIA decreased from time T3 to 3＂6, in group P and F compared with those of group C （ all P 〈 0.05 ）, with no significant difference between group P and F. The three groups showed no signifi- cant difference in resting VAS and coughing VAS at time T1 and T2, resting VAS and coughing VAS were significantly lower in group P and F than those of group C at different time points from T3 to T6 （ all P 〈 0.05）, with no significant difference between group P and F. At time T7, three groups showed significant difference in both resting VAS and coughing VAS （ all P 〈 0.05 ）. The three groups showed no significant differences in respiratory monitoring parameters at each time point. Group P and F showed a better evaluation of analgesic efficacy than that of group C （ all P 〈 0.05 ）. No severe adverse reactions were observed in any group. Conclusion When used in multimodal analgesia after VATS lobectomy, non-steroidal anti-inflammatory drugs enhance analgesic effect, do not increase incidence of adverse reactions, have little impact on breathing, and are conducive to expectoration.