联合氟比洛芬酯的多模式镇痛及配伍地塞米松对妇科腹腔镜日间手术后恢复的影响

Effects of multimodal analgesia combined with flurbiprofen and compatibility of dexamethasone on postoperative recovery after gynecological laparoscopic day-case surgery

目的探讨联合氟比洛芬酯的多模式镇痛及配伍地塞米松对妇科腹腔镜日间手术后恢复的影响。方法90例全身麻醉下行妇科腹腔镜日间手术的患者按完全随机分组法分为A、B、C三组（每组30例）：麻醉诱导时，A组和B组静脉注射0．1mg／kg地塞米松，C组静脉注射等容量生理盐水；麻醉诱导后，A组和C组静脉滴注1mg／kg氟比洛芬酯，B组静脉滴注等容量生理盐水，术毕均静脉注射昂丹司琼8mg。记录患者在术后0、2、4、6h和8h的视觉模拟评分（visual analogue scale，VAS）和舒适评分（bruggrmann comfort scale，BCS）及相关副反应。结果术后0、2hVAS评分A组明显低于C组（P〈0．05），C组明显低于B组（P〈0．05）；术后4hVAS评分A组和C组明显低于B组（P〈0．05）；术后0、2hBCS评分A组明显高于C组（P〈0．05），C组明显高于B组（P〈0．05）；术后4hBCS评分A组和C组明显高于B组（P〈0．05）。B组术后追加镇痛药物的发生率（23％）明显高于A组（0）和C组（10％）（P〈0．05）；B组和C组术后恶心呕吐（postoperative nausea and vomiting，PONV）的发生率（27％和30％）明显高于A组（3％）（P〈0．05）；B组和C组延长留观时间的发生率（23％和20％）明显高于A组（3％）（P〈0．05）。结论联合氟比洛芬酯的多模式镇痛及配伍地塞米松可显著提高妇科腹腔镜日间手术患者的术后舒适度。

Objective To discuss the effects of muhimodal analgesia combined with flurbiprofen and compatibility of dexamethasone on postoperative recovery after gynecological laparoscopic day-case surgery. Methods Ninety cases of patients undergoing elective gynecological laparoscopic day -case surgery were randomly divided into 3 groups （n =30）, during anesthesia induction： group A and B was given 0.1 mg/kg dexamethasone by intravenous injection, group C was given 2 ml normal saline by intravenous injection; after anesthesia induction： group A and group C was given 1 mg/kg flurbiprofen plus 0.9% NaCl 100 ml by intravenous injection slowly, group B was given normal saline by intravenous injection. All groups were given 8 mg ondansetronat at the end of surgery. The postoperative pain of the patients at 0,2,4,6 h and 8 h after surgery in 3 groups,was evaluated and recorded using a visual analogue scale（VAS） and bruggrmann comfort scale（BCS）. Other related adverse effects were also recorded. Results VAS scores at 0, 2 h after surgery was significantly lower in group A than in group C（P〈0.05）, group C was significantly lower than group B（P〈O.05）. VAS scores at 4 h after surgery was significantly lower in group A and C than in group B（P〈O.05）; BCS scores at 0, 2 h after surgery was significantly higher in group A than in group C（P〈0.05）, group C was significantly higher than group B（P〈 0.05）; BCS scores at 4h after surgery was significantly higher in group A and C than in group B （P〈0.05）. Compared to group A（0） and C （10%）, the incidence of using postoperative analgesic drugs was significantly higher in group B（23%）（P〈O.05 ）, the incidence of postoperative nausea and vomiting （ PONV ） were significantly higher in group B （ 27% ） and C （ 30% ） than that in group A（ 3% ） （P〈 0.05）; the incidence of extending stay time were significantly higher in group B（23%） and C（20%） than that in group A（3%）（P〈 0.05）. Conclusions Multimodal analgesia combined with flurbiprofen and compatibility of dexamethasone can significantly improve the comfort degree of patients after gynecologic laparoscopic day-csae surgery.