氟比洛芬酯在老年患者后路腰椎融合手术术后的镇痛效果观察

Efficacy of flurbiprofenaxetil for postopertative analgesia of lumbar fusion surgery in senile patients

目的观察氟比洛芬酯用于老年患者后路腰椎融合手术对患者术后镇痛效果的影响。方法 2012年8月~2013年5月在本院的择期行腰椎后路减压、椎间植骨融合、椎弓根螺钉内固定治疗术的老年患者90例,随机分为3组,试验组F1组分次静注氟比洛芬酯＋舒芬太尼[患者自控镇痛（patient controlled analgesia,PCA）]和F2组分次静注氟比洛芬酯＋舒芬太尼复合氟比洛芬酯（PCA）,对照组S组只用舒芬太尼（PCA）,每组30例。F1组和F2组在麻醉诱导后手术开始前预注氟比洛芬酯50 mg,手术结束前再次注射氟比洛芬酯50 mg。观察3组患者术后48 h内的镇痛效果[视觉模拟量表（visual analog scale,VAS）评分]、舒芬太尼用量、镇痛补救情况、不良反应发生率和术后48h伤口的引流量。结果 F1组和F2组的术后镇痛效果优于S组,术后2 h、6 h、24 h和48 h F1组以及F2组的VAS评分均低于各时点对照组的VAS评分,差异有统计学意义（P〈0.05）;F2组术后24 h和48 h的VAS评分低于F1组同时点的VAS评分,差异有统计学意义（P〈0.05）。S组术后有5例患者进行了镇痛补救,F1组和F2组没有患者需要镇痛补救。F1组和F2组术后舒芬太尼用量少于S组,差异有统计学意义（P〈0.05）;F1组（3/30）和F2组（3/30）术后不良反应发生率低于S组（11/30）,差异有统计学意义（P〈0.05）。结论老年患者腰椎后路融合术应用氟比洛芬酯复合舒芬太尼进行术后镇痛,在提高镇痛效果的同时,可以降低舒芬太尼用量,减少不良反应的发生。镇痛泵内复合氟比洛芬酯持续镇痛的效果较仅术前预注和术毕给予氟比洛芬酯的效果更佳。

Objective To evaluate the postoperative analgesic efficacy and safety of flurbiprofenaextilafter lumbar fusion surgery in senile patients. Methods From August 2012 to May 2013, 90 patinets undergoing elective posterior lumbar spine fusion and internal fixation surgery were randomly divided to 3 groups, Group F1 flurbiprofenaxetil iv bolus ＋ sufentanil [ patient controlled analgesia （PCA）], Group F2 flurbiprofenaxetil iv bolus ＋ flurbiprofenaxetil combined with sufentanil （PCA） and Group S sufentanil （PCA） with 30 patients each group. Flurbiprofenaxetil 50 mg was administrated intravenously in the Group F1 and Group F2 after anesthesia induction and before the incision. Another bolus of flurbiprofenaxeti150 mg was given before the end of operation. Efficacy and safety was assessed by pain score[ visual analog scale, （VAS）], tutal sufen- tanil consumption from PCA pump, need for pain rescue, side effects and drainage of blood in 48 h postoperation. Results Group F1 and Group F2 had significantly better analgesic effect than Group S at 2 h,6 h,24,48 h postoperative, the differ- ences were statistically significant （ P 〈 0.05 ）. The VAS scores in Group F2 were significantly lower than those in Group FI at 24 h and 48 h （P 〈0.05 ）. Pain rescue were supplied to 5 patients in Group S and none asked for pain rescue in Group F1 and Group F2. The consumption of sufentanil was significantly reduced in Group FI and Group F2 compared to Group S（ P 〈 O. 05 ）. The incidences of side effects in Group F1 （ 3/30 ） and Group F2 （ 3/30 ） were significantly less than that in Group S （ 11/30）, the differences were statistically significant（ P 〈 0.05 ）. Conclusion Perioperative administration of flurbiprofenax- etil results in significant pain relief, less consumption of sufentanil and lower incidences of side effects in 48 h postoperatively in senile patients posterior lumbar fusion operation. Flurbiprofenaxetil administrated intravenous bolus combined with PCA has a better analgesic effects than flurbiprofenaxetil administrated only intravenous bolus pre- and postoperatively.