帕瑞昔布钠复合吗啡与地佐辛复合氟比洛芬酯用于结肠癌患者术后镇痛效果比较

目的比较帕瑞昔布钠复合吗啡与氟比洛芬酯复合地佐辛用于结肠癌手术患者自控静脉镇痛（PCIA）的效果，探讨合适的镇痛方案。 方法选择ASAⅠ-Ⅱ择期行结肠癌手术的患者90例，随机分为帕瑞昔布钠组（P组）、地佐辛组（D组）和芬太尼组（F组），每组各30例。3组患者均采用气管内插管全身麻醉，术后行PCIA。PCIA设置背景剂量2ml/h，按压剂量2ml/次，锁定时间15min。P组于气管插管前静脉注射帕瑞昔布钠40mg，并于术后12、24、36、48 h静注帕瑞昔布钠40mg，PCIA使用吗啡20 mg+0.9%氯化钠溶液至100ml；D组于气管插管前静脉注射地佐辛5mg，PCIA使用地佐辛30 mg+氟比洛芬酯200mg+0.9%氯化钠溶液至100 ml；F组PCIA使用芬太尼1.0mg+0.9%氯化钠溶液至100 ml。观察3组患者术后30min（T_30min）、2h（T_2h）、4h（T_4h）、12h（T_12h）、24h（T_24h）、48h（T_48h）VAS镇痛评分、Ramsay镇静评分及不良反应的情况；术后48h记录PCIA泵按压次数及患者总体满意度。 结果P组及D组在T_30min-T_12h时点VAS评分显著低于F组（P﹤0.05）；T_30min-T_4h时点，P组Ramsay评分显著低于D组和F组（P﹤0.05）；术后48h内P组、D组患者头晕发生率显著低于F组（P﹤0.05）。 结论帕瑞昔布钠复合吗啡、地佐辛复合氟比洛芬酯用于结肠癌患者术后的镇痛效果确切，不良反应发生率低。

Postoperative patient controlled intravenous analgesia with parecoxib sodium combined with morphin and dezocine combined with flurbiprofen axetil after colon carcinoma surgery

ObjectiveTo evaluate the efficacy and safety of postoperative patient controlled intravenous analgesia (PCIA) with parecoxib sodium combined with morphin and dezocine combined with flurbiprofen axetil after colon carcinoma surgery. MethodsNinety patients with ASA Ⅰ-Ⅱundergoing elective colon carcinoma surgery were randomly assigned into three groups: parecoxib group (P group), dezocine group (D group) and fentanyl group (F group). They received endotracheal intubation general anesthesia and postoperative PCIA with the background infusion rate 2 ml/h, the bolus infusion rate 2 ml one time and lockout time 15 minutes. The patients in group P were administered parecoxib sodium 40 mg before intubation and 40 mg 12-, 24-, 36-, 48-h after surgery. The PCIA formulation in group P was morphine 20 mg in 100 ml normal saline. The patients in group D were administered dezocine 5 mg before intubation and the PCIA formulation was dezocine 30 mg+ flurbiprofen 200 mg in 100 ml normal saline. The PCIA formulation in group F was fentanyl 1 mg in 100 ml normal saline. VAS score, Ramsay sedation score and the adverse effects were recorded at 30 min (T_30min), 2 h (T_2h), 4 h (T_4h), 12 h (T_12h), 24 h (T_24h), 48 h (T_48h) after surgery. Patient pressing times and patients' satisfactory degree were evaluated 48 hours after surgery. ResultsAt T_{30 min} - T_12h time points, the VAS scores in patients of group P and D were lower than those in group F (P﹤0.05). At T_{30 min}-T_4h time points, the Ramsay sedation scores in patients of group P were lower than those in group D and group F (P﹤0.05). The incidences of dizziness during 48 h after surgery in group P and D were significantly lower than those in group F (P﹤0.05). ConculsionPCIA with both parecoxib sodium combined with morphin and dezocine combined with flurbiprofen axetil are effective for postoperative pain in patients undergoing colon carcinoma surgery.