氟比洛芬酯用于上腹部肿瘤术后静脉自控镇痛的效应观察

目的：观察氟比洛芬酯用于上腹部肿瘤手术术后静脉自控镇痛（PCIA）的疗效和超前镇痛的作用。方法：100例ASAI—Ⅱ级择期行上腹部肿瘤手术的患者，均采用静吸复合麻醉，术后PCIA镇痛，随机分为4组（n=25）：A组：术前不予氟比洛芬酯，术后芬太尼1mg＋生理盐水共100ml；B组：术前15min静脉缓注氟比洛芬酯50mg，术后芬太尼0．5mg＋生理盐水共100ml；C组：术前15min静脉缓注氟比洛芬酯50mg，术后氟比洛芬酯50mg＋芬太尼0、5mg＋生理盐水共100mg；D组：术前15min静脉缓注氟比洛芬酯50mg，术后氟比洛芬酯100mg＋芬太尼0，375mg＋生理盐水共100ml。观察术后24h内（2h，4h，12h，24h）的镇痛评分（VAS），PCA使用次数及不良反应发生情况。结果：术后2hB组、C组、D组的VAS评分都目月显低于A组（P〈0．05），术后12hC组、D组的VAS评分都明显低于A组、B组（P〈0，05），术后24h4组间VAS评分差异无统计学意义，术后24h内PCA按压次数4组相比差异无统计学意义，B组、C组、D组不良反应的发生率显著低于A组（P〈0．05），镇痛期间无呼吸抑制，异常出血等并发症发生。结论：氟比洛芬酯复合芬太尼用于上腹部肿瘤手术术后静脉镇痛效果良好，且有一定超前镇痛作用。可明显减少芬太尼的用量，同时降低不良反应的发生。

Effects of postoperative patient-controlled analgesia with flurbiprofen axetil after upper abdominal tumor operations

Objective To investigate the efficacy and the preemptive analgesic effect of postoperative patient-controlled analgesia with flurbiprofen axetil in patients undergoing upper abdominal tumor operations. Methods 100 patients(ASA I-II) were randomly allocated to four groups.Group A was treated postoperatively with fentanyl 1mg + NaCl to 100ml.Group B was injected flurbiprofen axetil 50 mg before the surgery and fentanyl 0.5mg + NaCl to 100ml postoperatively.Group C was injected flurbiprofen axetil 50 mg before the surgery and flurbiprofen axetil 50mg + fentanyl 0.5mg + NaCl to 100ml postoperatively.Group D was injected flurbiprofen axetil 50mg before the surgery and flurbiprofen axetil 100mg + fentanyl 0.375mg + NaCl to 100ml postoperatively.The visual analog scale(VAS),times of PCA and incidence of side effects were recorded at 2h,4h,12h,24h after operation.Result The VAS of group B,C and D at 2h was significantly less than that of group A(P<0.05),which became similar after 24h.The demanding times for supplemental bolus in four groups have no significant differences(P>0.05).The accidence of adverse effects of B,C and D were significantly less than that in group A (P<0.05).No respiratory depression or abnormal bleeding occurred in four groups.Conclusion Flurbiprofen axetil can produce preemptive effect and reduce requirement of fentanyl.And it can reduce the adverse effect and lead to higher patients satisfaction in patients undergoing upper abdominal tumor operations.