氢吗啡酮复合氟比洛芬酯在骨科下肢手术术后镇痛中的应用

Application of hydromorphone combined with flurbiprofen axetil for postoperative analgesia in lower extremity surgery

目的研究氢吗啡酮复合氟比洛芬酯在骨科下肢术后静脉自控镇痛(patient-controlled intravenous analgesia,PCIA)中的效果。方法收集本院在腰硬联合麻醉下行骨科下肢手术的患者90例,分为三组,SF组:舒芬太尼2~3μg/kg;H组:氢吗啡酮0.12~0.14 mg/kg;KH组:氢吗啡酮0.12 mg/kg+氟比洛芬50 mg。记录术后2 h、6 h、12 h、24 h、48 h的视觉模拟评分(visual analogue scale,VAS),按压次数,恶心、呕吐、呼吸抑制及消化道出血不良反应的发生。结果三组患者均未发生呕吐、呼吸抑制及消化道出血不良反应。与SF组比较,KH和H组恶心发生例数减少(P<0.05)。按压次数KH组低于SF和H组(P<0.05)。与SF和H组比较,KH组VAS评分明显降低(P<0.05)。结论氢吗啡酮复合氟比洛芬酯用于骨科下肢PCIA效果好,不良反应少,是一种安全有效的镇痛方法。

Objective To study the clinical effects of hydromorphone combined with flurbipro- fen axetil for postoperative analgesia in lower extremity surgery. Methods Ninety patients un- dergoing lower extremity surgery combined spinal-epidural anesthesia were randomly divided in- to three groups： SF group（ sufentanil 2 -3 μg/kg） ; H group（ hydromorphone 0. 12 - 0. 14 mg/ kg）; KH group（hydromorphone 0. 12 mg/kg ＋ flurbiprofen axetil 50 mg）. The VAS score, nausea, vomiting, respiratory depression and digestive tract bleeding were recorded at 2 h, 6 h, 12 h, 24 h and 48 h after surgery respectively. Results None of the three groups had vom- iting, respiratory depression and digestive tracthemorrhage. Compared with SF group, the inci- dence of nausea were decreased in H and KH groups （ P 〈 0. 05 ）. The number of effective anal- gesia pump pressure in KH group were less than SF and H groups（P 〈 0, 05 ）. Compared with SF and H groups, the VAS score was significantly decreased in KH group （P 〈 0. 05 ）. Con- clusion The effect of hydromorphone combined flurbiprofen axetil postoperative analgesia in lower extremity surgery are good, has less adverse reaction, and is a safe and effective method for postoperative analgesia.