舒芬太尼复合氟比洛芬酯用于全髋关节置换术术后静脉自控镇痛的效果

Effect of postoperative patient controlled intravenous analgesia with sufentanil combined with flurbiprofen axetil after total hip replacement surgery

目的：观察舒芬太尼复合氟比洛芬酯用于全髋关节置换术术后静脉自控镇痛（PCIA）的效果。方法：择期在腰硬联合麻醉下行全髋关节置换手术患者60例,其中男28例、女32例,年龄50-68岁,体重50-75 kg,ASAⅠ或Ⅱ级。术后PCIA随机分为两组（n=30）：舒芬太尼组（A组）和舒芬太尼＋氟比洛芬酯组（B组）。两组均采用负荷量＋持续剂量＋自控给药的模式,负荷量：A组为舒芬太尼5μg＋昂丹司琼4mg,B组为舒芬太尼5μg＋氟比洛芬酯50 mg＋昂丹司琼4 mg;持续剂量为2 mL/h,按压剂量为2 mL/次、锁定时间为15 min;镇痛液配方：A组为舒芬太尼150μg＋昂丹司琼8 mg,B组为舒芬太尼100μg＋氟比洛芬酯150 mg＋昂丹司琼8mg,两组均用0.9%氯化钠注射液稀释至100 mL。评估两组患者术后镇痛开始后2（T1）、4（T2）、8（T3）、24（T4）、48 h（T5）各时间点的疼痛视觉模拟评分（VAS）、Remesay镇静评分。同时记录术后镇痛48 h内总按压次数及不良反应的发生情况。结果：两组术后镇痛各观察时点的VAS评分、Remesay镇静评分、48 h总按压次数,组间比较差异无统计学意义（P〉0.05）。但B组患者恶心（0%）、呕吐（0%）、头晕（3.3%）不良反应发生率低于A组（10%、6.8%、26.7%）（P〈0.05）。结论：舒芬太尼复合氟比洛芬酯用于全髋关节置换术术后静脉自控镇痛,镇痛效果好,且舒芬太尼用量少及不良反应发生率低。

Objective： To evaluate the effcacy of postoperative patient controlled intravenous analgesia（ PCIA） with sufentanil combined with flurbiprofen axetil after total hip replacement surgery. Methods： 60 patients with total hip replacement surgery undergoing spinal epidural anesthesia（ 28 male and 32 female,aged50 to 68 years old,weighed 50 - 75 kg,ASA Ⅰ - Ⅱ）,were randomly divided into two groups（ n = 30 each） to received sufentanil（ group A） or sufentanil ＋ flurbiprofen axetil（ group B）. The PCIA used loading dose ＋controlled ＋ continuous mode of delivery. The loading dose in group A was sufentanil 5 μg ＋ ondansetron 4mg,and sufentanil 5 μg ＋ flurbiprofen axetil 50 mg ＋ ondansetron 4mg in group B. In 2 groups,the continued dose was2 mL / h,and the self-controlled dose was 2ml / time given by 15 min intervals. Sufentanil 150 μg ＋ ondansetron 8mg in group A and sufentanil 100 μg ＋ flurbiprofen axetil 150 mg ＋ ondansetron 8mg in group B were separately diluted to 100 ml with 0. 9% sodium chloride injection. Visual analogue scale（ VAS） and Remesay sedation scale at various time points[2（ T1）,4（ T2）,8（ T3）,24（ T4） and 48h（ T5） after the operation]were assessed. The number of pump pressing times during PCIA and the adverse effects associated with PCIA were recorded. Results： VAS score,Remesay sedation score at postoperative each time point and pump pressing times during PCIA were not statistically different between the two groups（ P〉0. 05）. However,group B had lower incidence of nausea（ 0%）,vomiting（ 0%） and dizziness（ 3. 3%） compared with group A（ 10%,6. 8%,and 26. 7%）（ P〈0. 05）. Conclusion： PCIA with sufentanil combined with flurbiprofen axetil could be effective method for postoperative analgesia in patients with total hip replacement surgery,and sufentanil less dosage and lower adverse reaction rate.