摘要
目的比较不同方式氟比洛芬酯复合芬太尼用于术后镇痛的效果。方法本研究为前瞻性、多中心、随机、双盲、对照、平行分组研究。选择2010年1月至2010年10月择期行骨科、胸外科、肝胆外科等大中型手术的病人，ASA分级Ⅰ或Ⅱ级，年龄14—91岁，体重35～95妇，采用随机数字表法，将其分为3组，A组：术毕即刻静脉注射氟比洛芬酯100mg，然后芬太尼1．0mg用生理盐水稀释至100ml，进行PCIA；B组：氟比洛芬酯200mg＋芬太尼0．6mg用生理盐水配稀释至100ml，进行PCIA；C组：术毕即刻静脉注射氟比洛芬酯100mg，氟比洛芬酯200mg＋芬太尼0．6mg用生理盐水稀释至100ml进行PCIA。3组背景输注速率2ml／h，PCA量2ml，锁定时间10min。分别于术毕、术后4、8和24h时记录静态和动态VAS评分和镇静评分。术后24h内记录镇痛有效、过度镇静、恶心、呕吐、瘙痒、头晕、嗜睡和呼吸抑制的发生情况。术后24和48h时随机选择一个中心B组镇痛泵内容物，取样后进行微生物培养试验。结果共完成2596例，其中A组875例、B组946例、C组775例。与A组比较，B组术毕、术后4、8和24h时静态和动态VAS评分和各时点镇静评分均降低，C组术毕、术后4、8h时静态和动态VAS评分均降低，术后4、8h时镇静评分升高，2组镇痛有效率均升高，B组过度镇静发生率降低，C组过度镇静发生蛊升高，2组术后恶心和呕吐的发生率降低，C组术后头晕发生率降低（P〈0．05）；与B组比较，C组各时点静态和动态VAS评分、镇痛有效率、恶心、呕吐以及瘙痒发生率差异无统计学意义（P〉0．05），术毕、术后4、8h时镇静评分升高，过度镇静发生率升高，头晕发生率降低（P〈0．05）。术后24、48h时泵内容物标本细菌和真菌培养均为阴性。结论对于大中型手术病人，氟比洛芬200mg复合芬太尼0．6mgPCIA（背景输注速率2ml／h，PCA量2ml，锁定时间10min）术后镇痛的效果更佳，且不良反应发生几率低。
Objective To compare the efficacy of flurbiprofen axetil combined with fentanyl administered using different modes for postoperative analgesia. Methods This was a prospective, muhicenter, randomized, double-blind, control, parallel-group study. ASA Ⅰ or Ⅱ patients, aged 14-91 yr, weighing 35-95 kg, sched- uled for orthopedic, thoracic or hepatobiliary surgery under general anesthesia from January 2010 to October 2010, were randomly divided into A, B and C groups. The three groups received patient-controlled intravenous analgesia （PCIA） after surgery. In group A, flurbiprofen axetil 100 mg was injected immediately after the end of surgery and then PCIA was performed with fentanyl 1.0 mg in 100 ml of normal saline. In group B, PCIA was performed withflurbiprofen axetil 200 mg and fentanyl 0.6 mg in 100 ml of normal saline. In group C, flurbiprofen axetil 100 mg was injected immediately after the end of surgery and then PCIA was performed with flurbiprofen axetil 200 mg and fentanyl 0.6 mg in 100 ml of normal saline. The PCA pump was set up with a 2 ml bolus dose, a 10 rain lockout interval and background infusion at a rate of 2 ml/h. VAS scores at rest and during activity and sedation score were recorded at the end of surgery and 4, 8 and 24 h after surgery. The effective analgesia, excessive sedation, nausea and vomiting, dizziness, somnolence and respiratory depression were recorded within 24 h after surgery. Samples from the PCIA bump were taken to do microbe culture experiment at 24 and 48 h after surgery. Results Two thou- sand five hundred and ninety-six cases completed this trial （875 cases in group A, 946 cases in group B and 775 cases in group C）. Compared With group A, VAS scores at rest and during activity at the end of surgery and 4, 8 and 24 h after surgery and sedation score were significantly decreased in group B, VAS scores at rest and during activity were significantly decreased at the end of surgery and 4 and 8 h after surgery and sedation scores were sig- nificantly increased at 4 and 8 h after surgery in group C, the rate of effective analgesia was increased in groups B and C, the incidence of excessive sedation was decreased in group B, while increased in group C, the incidence of postoperative nausea and vomiting was significantly decreased in groups B and C, and the incidence of postopera- tive dizziness was significantly decreased in group C （ P 〈 0.05 ）. Compared with group B, no significant change was found in the VAS scores at rest and during activity, rate of effective analgesia, and incidences of nausea and vomiting, and somnolence （P 〉 0.05）, sedation scores were significantly increased at the end of operation and 4 and 8 h after surgery, the incidence of excessive sedation was increased, and the incidence of postoperative dizzi- ness was decreased in group C （ P 〈 0. 05）. Neither bacterium nor fungus was found in the PCIA pump samples. Conclusion PCIA with flurbiprofen axetil 200 mg and fentanyl 0. 6 mg （background infusion at a rate of 2 ml/h, 2 ml bolus dose, 10 min lockout interval） provides better efficacy and the occurrence of sides effects is low for the patients undergoing moderate or major operations.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2013年第2期148-151,共4页
Chinese Journal of Anesthesiology
基金
国家自然科学基金面上资助项目（30872434,81171051）
关键词
氟比洛芬
芬太尼
镇痛
病人控制
疼痛
手术后
Flurbiprofen
Fentanyl
Analgesia, patient-controlled
Pain, postoperative
