两种非甾体类抗炎药联合氢吗啡酮在胸腔镜手术患者术后镇痛中的应用:一项随机、双盲、对照临床研究

目的 比较帕瑞昔布钠与氟比洛芬酯分别联合氢吗啡酮用于胸腔镜手术患者术后镇痛的效果及对炎性反应、肺部并发症的影响.方法 选择本院2017年2-11月行择期胸腔镜手术的患者156例,术后均行自控静脉镇痛(patient controlled intravenous analgesia,PCIA): 氢吗啡酮0.15 mg/kg +雷莫司琼0.6 mg + 生理盐水稀释至200 mL,流速为4 mL/h,单次PCA剂量1 mL,锁定时间15 min.采用随机数字表法分为3组: 分别在手术结束前30 min静脉注射帕瑞昔布钠40 mg(A组) 、氟比洛芬酯50 mg(B组) 及生理盐水5 mL(C组) .观察评估术后(术毕患者清醒) 0、6、12、24、48 h疼痛数字评分(numerical rating scale,NRS) ,不良反应,术后肺部并发症发生情况,术后24 h C反应蛋白(C-reaction protein,CRP) 、白细胞计数、中性粒百分率、血气分析及平均住院时间等指标.结果 术后6、12 h疼痛NRS评分A、B组均显著低于C组(P＜ 0.05) ,B组虽低于A组,但两组差异无统计学意义(P＞ 0.05);术后24、48 h疼痛NRS评分组内及组间比较差异均无统计学意义(P＞ 0.05) .与C组相比,术后24 hA、B组CRP均明显降低(P＜ 0.05) ,B组低于A组,但两组差异无统计学意义(P＞ 0.05) .恶心呕吐评分及术后肺部并发症发生例数组内及组间比较差异均无统计学意义(P＞ 0.05) .与C组相比,B组平均住院时间显著减少(P＜ 0.05) ,A组与C组比较差异无统计学意义(P＞ 0.05) ,B组平均住院时间较A组缩短1.32 d,但A组与B组差异无统计学意义(P＞ 0.05) .结论 手术结束前30 min使用帕瑞昔布钠或氟比洛芬酯均可增强氢吗啡酮胸腔镜手术患者术后镇痛效果,降低炎性反应,有助于患者术后康复,其中氟比洛芬酯或比帕瑞昔布钠更理想.

Analgesic effects of 2 nonsteroidal anti-inflammatory drugs respectively combined with hydromorphone in postoperative analgesia after thoracic surgery: a randomized,double blind,controlled clinical study

Objective To compare the postoperative analgesic effects of parecoxib and flurbiprofen axetil combined with hydromorphone respectively on the patients undergoing elective thoracoscopic surgery, and determine the effects on inflammation and postoperative pulmonary complications. Methods A total of 156 patients who underwent elective thoracoscopic surgery and then received postoperative patient-controlled intravenous analgesia (PCIA, 0.15 mg/kg hydromorphone + 0.6 mg ramosetron diluted with saline to 200 mL, infusion speed: 4 mL/h, single PCA dose: 1 mL, and lock time: 15 min) in our hospital from February to November 2017 were prospectively enrolled in this study. They were randomly divided into 3groups according to the intraoperative analgesic agents they received, that is, 40 mg parecoxib sodium (groupA), 50 mg flurbiprofen (group B) and 5 mL normal saline (group C), which were intravenously injected in 30 min before the end of surgery. Numerical rating scale (NRS) of postoperative pain and adverse reactions at6, 12, 24, 48 h after the operation, postoperative pulmonary complications, inflammatory cytokines (C-reaction protein, white cell count, and percentage of neutrophils) and blood gas analysis at 12 h postoperatively and length of hospital stay were recorded and compared between the 2 groups. Results Compared with group C, the NRS score was significantly lower in group A and group B at 6 and 12 h after operation (P＜0.05), and that of group B was lower than that of group A though no statistical difference (P＞ 0.05). The serum C-reaction protein level at 3 d after operation was significantly decreased in groups A and B than group C (P＜0.05), and the level of group B was lower than that of group A but there was no significant difference (P＞ 0.05). No significant differences were found in the scores of nausea and vomiting and the incidence of postoperative pulmonary complications in the intragroup and intergroup comparison (P＞0.05). Compared with group C, the mean length of hospitalization was significantly shorter in group B (P＜0.05), and there was no significant difference between group A and group C and between group A and group B (P＞ 0.05), though the length was 1.32 d shorter in group B than group A. Conclusion Application of both parecoxib sodium or flurbiprofen axetil in 30 min before the end of surgery can enhance the analgesic effect of hydromorphone after thoracoscopic surgery, reduce inflammation and help patients recover after operation. However, flurbiprofen axetil seems to be better than parecoxib sodium.