氟比洛芬酯复合瑞芬太尼在胃肠手术后自控镇痛中的应用研究

目的探讨氟比洛芬酯复合瑞芬太尼用于胃肠手术后自控镇痛（PCIA）的可行性及适宜剂量。方法择期行胃肠手术的患者80例，随机均分为4组，分别使用4种药物配伍镇痛。A组：氟比洛芬酯100mg＋芬太尼1．0mg＋0．9％氯化钠溶液至100mL；B组：氟比洛芬酯100mg＋瑞芬太尼0．5mg＋0．9％氯化钠溶液至100mL；C组：氟比洛芬酯100mg＋瑞芬太尼1．0mg-0．9％氯化钠溶液至100mL；D组：氟比洛芬酯100mg＋瑞芬太尼1．5mg＋0．9％氯化钠溶液至100mL。观察48h内的疼痛视觉模拟评分（VAS）及不良反应的发生情况。结果术后各时间点（6h、12h、24h、48h）C组与D组VAS评分均显著低于A组与B组，镇痛效果更加明显（P均〈0．05），AB组之间、CD组之间VAS评分无差异（P均〉0．05）。四组患者不良反应发生率差异有统计学意义（χ2=88．7，P=0．01），B组和C组明显低于A组和D组。结论氟比洛芬酯100mg＋瑞芬太尼1．0mg配伍应用于PCIA，镇痛效果和安全性优于氟比洛芬酯复合芬太尼以及其他浓度瑞芬太尼组，是胃肠手术后理想的镇痛方式。

Clinical Observation of Postoperative Patient Controlled Intravenous Analgesia with Flurbiprofen Axeyil Injection Combined with Remifentanil in Patients Underwent Gastrointestinal Surgery

Objective To assess analgesic effect of flurbiprofen axeyil injection combined with remffentanil for patient controlled intravenous analgesia （PCIA）in patients underwent gastrointestinal surgery. Methods 80 patients underwent gastrointestinal surgery were evenly randomized into A,B,C,D four groups. For postoperative PCIA,the patients in group A received flurbiprofen axeyil（100mg） ＋fentanyl（1.0mg）＋0.9%Nacl solution to 100 mL,those in group B had flurbiprofen axeyil（100mg）＋remifentanil（0.5mg）＋0.9%Nacl solution to 100 mL,those in group C bad flurbiprofen axeyil（100mg）＋remifentanil（1.0mg）＋0.9%Nacl solution to 100 mL,those in group D had flurbiprofen axeyil （100mg）＋ remifentanil （1.5mg）＋0.9%Nacl solution to 100 mL. All the anesthetic agents were diluted to 100mL. The visual analog scale （VAS）and incidence of side effects were observed during 48 hours after operation. Results In 6h,12h,24h,48h after operation,the VAS in group C and group D were better than that in group A and group B（All P〈0.05）. There were statistical differences for VAS neither between group A and group B nor between group C and group D（All P〉0.05）. The incidence of side effects in four groups had statistically significant differences （ χ 2=88-7, P=-0.01 ）. The side effects in group B and group C were less than that in group A and group D. Conehmion PCIA with flurbiprofen axeyil （100mg）injection combined with remifentanil（1.0mg）in patients after gastrointestinal surgery can achieve satisfactory analgesia and reduce side effects.