氯诺昔康在骨科手术后患者自控镇痛效果的临床观察

目的探讨在骨科手术后患者自控镇痛(PCA)中应用非甾体类抗炎药氯诺昔康的镇痛效果。方法择期行骨科手术患者110例,术后随机分为氯诺昔康组(L组)55例和吗啡组(M组)55例接受PCA治疗。PCA药物配方分别为:氯诺昔康组给氯诺昔康32mg加生理盐水稀释至100mL;吗啡组给0.05%吗啡100mL。手术结束前缝合深层组织时给予患者静脉连接PCA泵。背景输注速率2mL/h,单次PCA剂量0.5mL,锁定时间15min。术后定时观察视觉模拟评分法(VAS)的评分及不良反应的发生等情况。结果L组在术后4、8、16、20、24、32和48h的VAS评分均为M组相应各时间点的参数要低,但无显著差异(P>0.05)。结论氯诺昔康应用于骨科手术后PCA的镇痛效果及耐受性好,镇痛效果接近于吗啡,头晕和胃肠道不良反应的发生率低。

Clinical Investigation of the Effect of Patient-controlled Analgesia with Lornoxicam in Patients Undergoing Orthopaedics Surgery

Objective To investigate the effect of patient-controlled analgesia （PCA） with lomoxicam as compared with those with morphine. Methods 110 ASA Ⅰ-Ⅱ patients scheduled for orthopedics were studied, The patients were premedicated with intramuscular phenobarbital with intramuscular Phenobarbital 0.1g and atropine 0.5mg. Epidural catheter was inserted in a eephala direction for 4cm into epidural space via the Tuohy needle at L2-3. The loading dose was 2% lidocaine and 1 ： 200000 adrenaline solution 8-12mL. The level of block was T9. The patients received continuous epidural infusion of 2% lidocaine and 1 ： 200000 adrenaline solution at a rate of 3-6mL/hl during operation. The patients were randomly divided into two groups according to the drugs of postoperative analgesia： lomoxicam group （group L, n=55） received lomoxicam intravenous infusion at a rate of 0.64mg/h and morphine group （group M, n=55） received morphine intravenous infusion at a rate of 0.64 mg/h. In both groups the patients were received PCA with the bolus dose of 0.5mL and lockout interval of 15min. Efficacy of analgesia were assessed by VAS score. Side effects were observed. Results There was no significant difference in the mean VAS score between group L and group M at 4, 8, 16, 20, 24, 32 and 48h. There was no significant difference in side effects such as dizzy, drowsiness and pruritus between the two groups except the occurrence of nausea and vomiting which was lower in group Lthan in group M （P〉0.05）. Conclusion Continuous intravenous infusion of lomoxicam can provide satisfactory postoperative pain relief with fewer side effects compared with morphine.