氟比洛芬酯用于腹腔镜大手术后静脉镇痛的临床研究

目的探讨氟比洛芬酯复合芬太尼用于腹腔镜大手术后静脉镇痛的效果。方法选择40例择期行腹腔镜大手术的患者,按随机数字表法分为KF组(氟比洛芬酯复合芬太尼组)、F组(芬太尼组),每组20例,术后均行静脉自控镇痛(PCIA)。PCIA配方:KF组为氟比洛芬酯6 mg/kg加芬太尼10μg/kg,F组为芬太尼15μg/kg,均加0.9%氯化钠溶液稀释至120 mL。观察并记录2组患者在术后1 h、4 h、12 h、24 h、48 h的视觉模拟(VAS)评分、镇静评分(Ramsay评分)、舒适度评分(BCS评分)、PCIA按压次数、不良反应以及各时点的生命征、血氧饱和度,并测定术前(T0)、术后48 h(T48)肝肾功能。结果两组在术后各时间点的生命征、血氧饱和度、肝肾功能组内、组间比较差异无统计学意义(P0.05)。两组患者VAS评分、BCS评分于各时点的组内差异无统计学意义(P0.05),Ramsay评分在F组于12 h后、KF组于4 h后开始显著降低(P0.05);KF组在术后4 h以后的BCS评分、VAS评分优于F组,两组在术后各时点的Ramsay评分差异无统计学意义(P0.05)。KF组按压次数少于F组。F组有2例患者于术后4 h需要补救措施来缓解疼痛,而KF组无需补救措施者。KF组不良反应发生例数显著少于F组。结论氟比洛芬酯6 mg/kg复合芬太尼10μg/kg用于腹腔镜大手术后静脉镇痛,比单独用芬太尼15μg/kg的效果更确切,舒适度更高、不良反应更少,是安全可行的镇痛方法。

Clinical research of flubiprofen axetil for postoperative analgesia after laparoscopic major operation

Objective To investigate the effect of intravenous patient-controlled analgesia （PCIA） with flurbiprofen axetil and fentany after laparoscopic major operation. Methods Forty patients scheduled for laparoscopic major operation were randomly divided into KF group（flurbiprofen axetil combined with fentany group） F group（fentany group）,each had 20 patients. PCIA was performed in all the patients at the end of surgery. PCIA ingredients were as follows： in KF group, flurbiprofen axetil 6 mg/kg＋fentany 10μg/kg with 0.9% normal saline diluted to 120ml;and in F group, fentany 15μg/kg with 0.9% normal saline diluted to 120ml. Visual analogue scale （VAS）,Bruggrmann comfort scale（BCS）,Ramsay score, the total press times of PCIA, side effects, blood pressure, heart rate, breath rate, and pulse oxygen saturation （SpO2） were recorded at 1h,4h,12h,24h,48h after operation. And liver function, renal function before the operation and 48 h after operation were also measured. Results There was no statistical difference in the heart rate, blood pressure,SpO2,liver function, or renal function between the two groups. No significant difference in VAS score and BCS score at each time point of both groups was noticed. Ramsay score significantly decreased 12 h after operation in F group and 4h after operation in KF group. VAS and BCS in KF group were significantly better than those in the F group 4 h after operation. No significant difference in Ramsay score at each time point between the two groups existed. KF group had less total press times and side effects than F group. Two patients needed remedial measures in F group, but none in KF group. Conclusion Combined flubiprofen axetil 6mg/kg with fentany 10μg/kg is a safe and feasible method for postoperative analgesia after laparoscopic major operation. Compared with fentany 15 μg/kg alone, it is more effective, with higher patient satisfaction and lower incidence rate of side effects.