氯诺昔康联合小剂量芬太尼术后镇痛的效果及对应激反应的影响

目的评价氯诺昔康联合小剂量芬太尼用于上腹部手术后患者自控镇痛(PCA)的效果、不良反应及对术后应激反应的影响。方法将择期上腹部手术患者36例随机分为芬太尼镇痛组(A组)、氯诺昔康+芬太尼镇痛组(B组)和未镇痛组(C组)。观察患者术后6 h、24 h和48 h疼痛视觉模拟评分(VAS)和镇静程度评分;检测麻醉前和术后24 h血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)浓度。结果各时点VAS评分,A、B组比较无显著性差异(P>0.05);各时点镇静评分B组均优于A组(P<0.05);术后24 h,A组、B组血清CRP和IL-6水平均明显低于C组(P<0.05),且B组低于A组(P<0.05);3组患者术后镇痛相关恶心、呕吐、眩晕等不良反应发生率无明显差异。结论氯诺昔康与小剂量芬太尼联合用于PCA,既可显著减少阿片类药物的用量,又可达到满意的镇痛效果,可有效缓解术后疼痛引起的过度应激反应。

Effects of postoperative analgesia with lornoxicam combined low dose fentanyl on the stress responses

Objective It is to investigate the effects of postoperative patient controlled analgesia(PCA) with Lornoxicam combined with low dose of Fentanyl and its effect on the stress responses undergoing upper abdominal surgery.Methods Thirty six patients undergoing upper abdominal surgery were divided into fentanyl PCA group(group A),fentanyl plus lornoxicam PCA group(group B),without PCA group(group C).The VAS scores,the sedation scores were observed at 6,24 and 48 h after operation,and the levels of serum CRP,IL-6 were measured before anesthesia and 24h after operation.Results There was no significant difference in the VAS scores at every time between group A and group B(P>0.05),but the sedation scores at every time in group B was better than that in group A(P<0.05). The difference of the preoperative levels of serum CRP and IL-6 of the group A and group B were significantly lower than those of group C(P<0.05),and the levels in group B were lower than those in group A(P<0.05).There were no difference in vomit,nausea and vertigo among the three groups.Conclusions PCA with Lornoxicam combined with low dose of fentanyl not only can reduce the requirement of fentanyl,but also has a satisfactory analgesia effect,so it can alleviate the stress responses induced by postoperative pain effectively.