氯诺昔康静脉自控镇痛与吗啡硬膜外自控镇痛的临床比较

目的 比较骨科手术后患者氯诺昔康静脉自控镇痛（PICA）与吗啡硬膜外自控镇痛（PCEA）的临床效果和不良反应。方法 100例ASAⅠ～Ⅱ骨科择期手术患者随机分为两组：PICA（n=50）和PCEA组（n=50）。PICA组于手术结束前约30min静注氯诺昔康8mg和恩丹西琼（恩丹西酮）4mg后连接镇痛泵（48mg氯诺昔康＋生理盐水至100m1）；PCEA组于手术结束前约30min硬膜外腔注入吗啡1mg和恩丹西酮4mg加生理盐水至10ml后连接镇痛泵（9mg吗啡＋布比卡因150mg＋生理盐水至100m1）。连续量为2ml／h，自控量为0．5ml／15min。术后连续监测BP、RR、ECG、Sp02，定时观察记录视觉模拟评分法（VAS）及恶心呕吐、嗜睡、多汗、皮肤瘙痒等不良反应的发生情况。结果 两组术后4h、8h、16h、20h、24h、32h和48h各时间点的VAS评分吗啡PCEA组略低于氯诺昔康PICA组，但差异无显著意义（P〉0．05）。恶心、呕吐、嗜睡、多汗、皮肤瘙痒发生率PCEA组明显多于PICA组（P〈0．05）。结论 骨科手术后氯诺昔康PICA与吗啡PCEA均有良好的镇痛效果，但氯诺昔康PICA组不良反应较少，值得临床推广应用。

Comparative study of postoperative patient-controlled intravenous anagesia with lornoxicam and patient-contronlled epidural analgesia with morphine in patient undergoing orthopaedics surgery

Objective To compare the analgesic efficacy and side effects of patient-controlled intravenous analgesia (PICA) with lornoxicam and patient-controlled epidural analgesia (PCEA) with morphine in patient undergoing orthopaedics surgery. Methods 100 ASA I - D patients scheduled for orthopaedics surgery were divided randomly into two groups: lornoxicam PICA group (n=50 ). lornoxicam 48mg was diluted to 100ml with normal saline(0. 9%NS). Morphine PCEA group( n=50),morphine 9mg+ bupivacaine 150mg were diluted to 100ml with normal saline(0. 9% NS). In both groups the patients received PCA at rate of 2ml/h with the bolus does of 0. 5ml and lockout interval of 15min. The loading dose was lornoxicam 8mg plus ondansetron 4mg in group PICA and morphine 1mg and ondansetron 4mg diluted to 10ml with normal saline(0. 9% NS) in group PCEA 30 minutes before the end of operation. BP,RR,ECG,SpO2 were minitored continuously after operation. Efficacy of analgesia was assessed by VAS scores.Side effects such as drowsiness,sweat,nausea,vomiting and skin pruritus were also observed. Results There was no significant difference in the mean VAS score between group PICA and group PCEA at 4h, 8h. 16h,20h,24h,32h and 48h,after operation. There was no significant difference in side effects between the group except the occurrence of sweat, nausea, vomiting and skin pruritus which was lower in group PICA than in group PCEA(P< 0-05). Conclusion PICA with lornoxicam can provide satisfactory pain relief with fewer side effects compared with morphine PCEA.