中西药联合用于老年肥胖全髋关节置换术后的镇痛效果研究

Effects of Flurbiprofen Combined with Tramadol on People Controlled Intravenous Analgesia after Total Hip Replacement Surgery in Elderly Obese Patients

目的：评价氟比洛芬酯复合曲马多联合中药用于老年肥胖患者髋关节置换术后静脉自控镇痛的效果,并与单纯曲马多静脉镇痛进行对比。方法：选择ASAⅠ~Ⅲ级行全髋关节置换术的老年肥胖患者60例（BMI〉30 kg/m2）,随机分为2组：氟比洛芬酯复合曲马多组（A组,n=30）和单纯曲马多组（B组,n=30）,两组患者均接受腰硬联合麻醉。手术结束前20 min,A、B两组分别缓慢静脉注射氟比洛芬酯50 mg和曲马多100 mg,后连接患者自控静脉镇痛（PCIA）,其中A组：氟比洛芬酯100 mg＋曲马多500 mg＋0.9%生理盐水＋盐酸托烷司琼4 mg＋中药自拟益气活血汤;B组：曲马多1000 mg＋0.9%生理盐水＋盐酸托烷司琼4 mg,每组总量为100 mL。PCIA模式：背景量2 mL/h,PCA 2 mL,锁定时间15 min。记录两组患者手术结束后2 h、6 h、24h、48 h各时段静息、及活动下视觉模拟疼痛评分（VAS）以及镇静程度和不良反应发生率。结果：两组患者在术后2 h、6 h、24 h、48 h静息、活动时的VAS评分、镇静满意度间无统计学差异;与B组相比,A组不良反应发生率明显减少（16.7%Vs 90.0%,P〈0.01）。结论：使用氟比洛芬酯复合曲马多联合中药汤剂益气活血汤,术后患者自控静脉镇痛效果明显,不良反应发生率低,是老年肥胖患者全髋关节置换术后较为理想的镇痛方法。

Objective： To investigate the effects of flubiprofen combined with tramadol on people-controlled intravenous analgesia（ PCIA） compared with tramadol alone after total hip replacement（ THR） surgery in elderly obese patients. Methods： Sixty elderly obese patients（ ASAⅠ ~ Ⅲ,BMI 30 kg / m2） who underwent unilateral THR surgery were randomly divided into two groups： Group A and Group B. All of them received combined spinal-epidural anesthesia（ CSEA）. Twenty minutes before the end of the surgery the patients in Group A and B received flubiprofen 50 mg. iv and tramadol 100mg. iv respectively,then PCIA（ A： flubiprofen 100mg combined with tramadol 500 mg and tropisetron hydrochloride 4 mg; B： tramadol 1000 mg combined with tropisetron hydrochloride 4mg） was performed. The drugs in each group were diluted to 100 mL. The analgesic pattern was background flow rate of 2 mL / h,2 mL PCA and locking time of 15 min. The VAS pain scores during rest and activity,Ramsay sedation scores and side effects were recorded at 2 h,6h,24 h,48 h and 72 h post operation. Results： There was no difference in the VAS scores at rest or during initiative activity for all time points and the satisfactory of sedation degree between two groups was also the same. Compared with Group B,a significantly lower incidence of side effects was observed（ 16. 7% Vs 90. 0%,P〈0. 01） in Group A. Conclusion： As far as the combined usage of flubiprofen and tramadol in PCIA is concerned,it can provide not only better pain relief,but also fewer side effects. Therefore,it is an ideal method for post-operative analgesia for elderly obese patients after THR surgery.