氟比洛芬酯用于颅脑手术患者的镇痛效果及凝血功能的影响

目的观察不同剂量氟比洛芬酯(FP)注射液复合吗啡用于颅脑手术患者术后镇痛的效果及其对术后凝血功能的影响。方法选择择期行神经外科开颅手术患者60例,术后患者自控镇痛(PCA),随机分为三组。吗啡组(M组):吗啡30 mg;FP 1组(F1组):吗啡20 mg+FP 1 mg/(kg?d);FP 2组(F2组):吗啡20 mg+FP 2 mg/(kg?d),每组各20例。手术开始前5 min,M组给予生理盐水5 mL,F1、F2组给予FP 1 mg/kg。记录PCA治疗后4、16、24、48 h静息和运动(张口、咬)状态的VAS评分。采用血栓弹力图(TEG)检测麻醉前、术后24、48、72 h凝血功能状态。结果镇痛泵给药后24、48 h F1、F2组(静息、运动)VAS评分低于M组(P<0.05),F1、F2组的VAS评分差异无统计学意义。麻醉前、术后24、48、72 h四组患者TEG结果参数R、K、ANG(α角)、MA(最大振幅)、CI(凝血指数)比较差异无统计学意义,术后72 h F2组MA、CI下降。结论术中单次使用氟比洛芬酯1 mg/kg且术后PCA泵使用吗啡20 mg复合氟比洛芬酯1 mg/(kg?d),用于颅脑手术患者镇痛效果满意且不影响凝血功能。

The Effects of Flurbiprofen on Postoperative Analgesia and Coagulation for Craniotomy Patients

Objective To investigate the effects of different doses flurbiprofen （FP） combined with morphine on postoperative analgesia and coagulation for craniotomy patients. Methods 60 patients scheduled for elective neurosurgery with patient-controlled analgesia （PCA） for postoperative analgesia. All patients were randomly divided into three groups with 20 each. Morphine group （group M）：morphine 30 mg, FP1 group （group F1）：morphine 20 mg＋FP 1 mg/（kg·d）, FP2 group （group F2）：morphine 20 mg＋FP 2 mg/（kg·d）. Group M was given normal saline 5 mL and the other two groups were given FP （1 mg/kg） 5 min before surgery. The scores of VAS （rest and movement） were recorded at 4, 16, 24 and 48 h after the PCA treatment. The coagulation was measured at before anesthesia, 24, 48 and 72 h after surgery by thrombelastography （TEG）. Results The VAS scores at 24, 48 h after the PCA treatment of group F1 and F2 were lower than group M（P〈0.05）. The VAS scores between group F1 and F2 showed no significant difference. The R, K, ANG （αAngle）, MA （Maximum amplitude）, CI （coagulation index） measured by TEG showed no significant difference among these three groups. The MA and CI declined at 72 h after the surgery in group F2. Conclusion The intravenous infusion of FP 1 mg/kg before surgery and combined with PCA pump given morphine 20 mg and FP 1 mg/（kg？d） shows satisfactory analgesia effects and no effects on coagulation for neurosurgery.