布洛芬缓释胶囊治疗腰椎融合术后疼痛疗效分析

目的评价布洛芬缓释胶囊（芬必得）对腰椎融合手术后急性疼痛的疗效。方法将60例准备接受腰椎融合手术的患者按照随机双盲方法分为2组：布洛芬加阿片类药物组（芬必得组）和塞来昔布加阿片类药物组（塞来昔布组）。塞来昔布组患者术前8 h口服塞来昔布片200 mg,术后1～5 d每12 h口服200 mg;芬必得组术前8 h服用维生素C 100 mg,术后6 h服用芬必得900 mg,之后1～5 d每12 h服用900 mg。两组均在术后第1天采用PCA装置给予芬太尼镇痛以及术后2～5 d改为口服奇曼丁镇痛。术后两组病人均应用奥美拉唑预防应激性溃疡。于术后4、8、12、16、24、36、72、96 h行VAS评分评估手术后镇痛效果,并记录PCA药物用量。结果在术后8 h以内及手术后96 h两组患者手术切口疼痛的VAS评分结果无统计学意义（P〉0.05）,而术后8～72 h,芬必得组VAS评分较塞来昔布组更低（P〈0.05）。术后1～8 h芬太尼用量两组没有统计学差异（P〉0.05）,术后12～24 h芬必得组芬太尼用量较小（P〈0.05）。术后1 d两组患者口服奇曼丁用量无统计学差异（P〉0.05）,术后2～5 d芬必得组奇曼丁用量更小（P〈0.05）。术后1～5 d两组恶心、呕吐次数无统计学差异（P〉0.05）。结论腰椎融合手术后短期应用布洛芬缓释胶囊辅助镇痛,镇痛疗效优于塞来昔布,可减少阿片类药物用量,胃肠道副反应未见增加。

Efficay of Ibuprofen for postoperative pain after lumbar spinal fusion

Obective To evaluate the efficacy of Ibuprofen（Fenbid） in the treatment of postoperative pain after lumbar spinal fusion.Methods Totally 60 patients preparing to receive lumbar spinal fusion were divided into Ibuprofen plus Opioids group（Fenbid group） and Celecoxib plus Opioids group（Celecoxib group） according to double blind trial.Patients in Celecoxib group were received 200 mg Celecoxib before operation and every 12 hours in the following 1～5 days.Patients in Ibuprofen group were given 100 mg vitamin C before operation and 900 mg Ibuprofen 6 hours after operation and every 12 hours in following 1～5 days.All patients were received Fentanyl through patient-controlled analgesia（PCA） pump at the first day after operation and took Tramadol orally in the following 2～5 days to relieve pain.Omeprazol was applied to prevent stress ulcer.Analgesic effect was evaluated using visual analog scores（VAS） at 4、8、12、16、24、36、72、96 hours after operation and doses of PCA drug were recorded.Results There was no statistical difference in VAS scores between two groups within 8 hours and at 96 hours post surgery（P0.05）,however the VAS scores in Fenbid group were lower than those in Celecoxib group significantly at 8～72 hours post surgery（P0.05）.There was no statistical difference in the dosage of Fentanyl between two groups within 8 hours post surgery（P0.05）,however,the dosage was lower in Fenbid group at 12~14h post surgery.No statistic difference in oral dosage of Tramadol was found between two groups at the first day post surgery（P0.05）,however,the dosage was lower in Fenbid group than that in Celecoxib group at 2～5 days post surgery（P0.05）.No statistic difference in the frequency of nausea and vomiting at 1～5 days post surgery was found（P0.05）.Conclusion Short-term oral administration of Ibuprofen after lumbar spinal fusion can get better analgesic effect than Celecoxib and can reduce the opioids requirements without increasing the incidences of gastrointestinal reactions.