【www.zhangdahai.com--感谢信】
[摘要] 目的 分析手术期间应用氟比洛芬酯对全麻苏醒的影响及术后镇痛效果。方法 选取择期腹腔镜胆囊、妇科手术患者各20例;每组又随机分为氟比洛芬酯胆囊、妇科镇痛组和脂肪乳对照组,每组各10例。常规实施全麻。于手术结束前,停止使用气腹时,开始实验。镇痛实验组一次性静脉注射氟比洛芬酯lmg/kg;对照组一次性静脉注射脂肪乳0.lmL/kg。以给药为起始点,给药后5、15、30、60、120、240、480min,12h和24h,视觉模拟疼痛评分(VAS评分)、术后首次疼痛的时间、术后镇痛药的应用情况、术后恶心、呕吐等不良反应发生率,以及出血量等。结果 各部位手术的镇痛实验组术后首次出现疼痛的时间明显晚于对照组;镇痛实验组术后的镇痛药用量也明显少于对照组.腹腔镜胆囊手术的镇痛实验组VAS评分于给药后30min、60min、120min、240min、480min、12h及24h时低于对照组,具有统计学差异;腹腔镜妇科手术的镇痛实验组VAS评分于给药后30min、60min、120min及24h时低于对照组,具有统计学差异。术后恶心、呕吐的发生率,各部位手术的镇痛实验组与对照组均无明显统计学差异;腹腔镜胆囊手术组的镇痛实验组的尿管刺激与术后躁动的发生率明显低于对照组,腹腔镜妇科手术组的尿管刺激的发生率明显低于对照组。结论 手术期间停止使用气腹时一次性静脉注射氟比洛芬酯,具有镇痛效果明显、持续时间长、不良反应发生率低、操作简便易行、不影响全麻苏醒等特点,可安全使用。
[关键词] 术后镇痛; 腹腔镜; 氟比洛芬酯
[中图分类号] R614.2 [文献标识码] A [文章编号] 1673-9701(2009)23-103-03
Analysis of the Effectivencss of Flurbiprofen in Postoperative Analgesia in Laparoscopic Operation of Different Parts
SHI Honglei HUANG Yan
Pengpai Memorial Hospital of Haifeng County,Guangdong 516400,China
[Abstract] ObjestiveTo observe the influence offlurbiprofen on general anesthesia analepsia and effectiveness in postoperative analgesia and its adverse effects. MethodsTwenty patients undergoing cholecyst laparoscopic operation(group A)and twenty patients undergoing gynecological laparosc opicoperation(group B) were enrolled.Patients in each group were then respective1y random1y assigned into two groups of equa1 size,the study groups(group Al and group B1) and the control groups(group A2 and group B2). All patients received routine general anesthesia. Before the end of the operation,the study began when the aeroperitonia was stopped,the study groups received a bolus intravenous administration of lmg/kg flurbiprofen,the control groups received a bolus intravenous administration of 0.1mL/kg fat milk at 5,15,30,60,120, 240,480min,12h and 24h after the administration of flurbiprofen or fat milk,the VAS score,the time of the first postoperative pain,the postoperative usage of analgesic drugs,the occurrence of adverse effects like nausea and omiting,and the blood loss were observed during the analepsia period of general anesthesia In each group. ResultsIn the study groups the times of the first postoperative pain were significantly later than ones in the corresponding control groups,and the amounts of the postoperative analgesic drugs were significantly lesser and the postoperative VAS scores were significant1y 1ower,there were statistically significant differences between the study groups and the control groups. ConclusionOne bolus intravenous administration of flurbiproefn during the operation suggests the characteristics of significant analgesic effect,long duration,low occurrence of adverse efects,convenient performance and no influence on general anesthesia analepsia,and is safe to be used.
[Key Words]Postoperative analgesia; Flurbiprofen; Laparoscopy
术后镇痛可以减轻患者的疼痛和不适,减少并发症,促进术后康复。传统的术后镇痛治疗常以阿片类药物为主,围术期副作用多,因此寻求镇痛效果好、副作用少、不产生依赖性的新的术后镇痛药和方法则成为必然。氟比洛芬酯是临床上广泛使用的非甾体抗炎药,常用于治疗术后疼痛及癌痛,但手术期间应用氟比洛芬酯报道尚少[1]。我们通过手术期间应用氟比洛芬酯,观察其对全麻苏醒的影响及术后镇痛的效果和不良反应的情况,评价其在临床的应用价值。
1 资料与方法
1.1 一般资料
择期腹腔镜胆囊手术(A胆囊手术组)和腹腔镜妇科手术(B妇科手术组)组各20例;年龄21～65岁。每组又随机分为氟比洛芬酯镇痛组(A1胆囊镇痛组、B1妇科镇痛组)和脂肪乳对照组(A2胆囊对照组、B2妇科对照组),每组各10例。所有患者均无心血管疾病、严重高血压、肝肾疾病、消化道溃疡及凝血功能异常疾病,实验开始前一周内未应用过奎诺酮类抗生素药物(如氟呱酸、依诺沙星、洛美沙星、诺氟沙星等),无氟比洛芬酯过敏者和阿司匹林哮喘史者。患者在性别、年龄、体重方面无显著性差异。
1.2 方法
患者不应用术前药,采用全身麻醉。麻醉诱导[2]以咪达唑仑0.lmg/kg,芬太尼2μg/kg,维库溴铵0.lmg/kg,异丙酚1～1.5mg/kg, 密闭面罩吸氧过度通气后行气管插管,机械通气,调整好机械通气各参数,维持呼气末二氧化碳分压(ETC02)为35～45mmHg。麻醉维持[3]采用静脉一吸入复合麻醉维持,静脉持续泵入异丙酚4～5mg/(kg・h),同时吸入异氟醚1～1.5MAc,必要时追加芬太尼0.05～0.1mg,维库溴铵2～4mg。手术结束前,当停止使用气腹时,开始给药,氟比洛芬酯1mg/kg,或脂肪乳0.lmL/kg。
1.3 观察项目
注药后由实施麻醉者观察如下项目:(1)病人术后首次述说疼痛的时间,若24h内仍未感到疼痛定为1440min;(2)术后应用镇痛药的情况,包括用药名称、用药量及给药时间;(3)病人术后视觉模拟疼痛程度评分(VAS评分):0分为无痛,0～1分为强烈疼痛; 1～3分为轻度疼痛,4～6分为中度疼痛,7～10 分为重度痛。(6)术后恶心、呕吐、躁动及尿管刺激疼痛的发生率,以及术中、术后出血量。
1.4 统计学分析
采用SPSS 11.0软件进行统计学分析。计量资料均以χ±s表示,采用t检验进行组间差异的显著性检验;计数资料采用卡方检验。P
