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氟比洛芬酯联合氢吗啡酮用于骨科术后静脉自控镇痛的镇痛、镇静效果及安全性
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| 篇名： | 氟比洛芬酯联合氢吗啡酮用于骨科术后静脉自控镇痛的镇痛、镇静效果及安全性 |
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| 摘要： | 目的：观察氟比洛芬酯联合氢吗啡酮用于骨科术后静脉自控镇痛（PCIA）的镇痛、镇静效果及安全性。方法：选择2016年5月－2018年1月承德医学院附属医院麻醉科收治的90例椎管内麻醉下行骨科下肢手术的患者，按随机数字表法分为SF组、H组和KH组，每组30例。术后PCIA泵药液配方SF组为枸橼酸舒芬太尼注射液2～3 μg/kg+注射用盐酸托烷司琼10 mg+0.9％氯化钠注射液稀释至100 mL；H组为盐酸氢吗啡酮注射液0.12 mg/kg+注射用盐酸托烷司琼10 mg+0.9％氯化钠注射液稀释至100 mL；KH组为盐酸氢吗啡酮注射液0.12 mg/kg+氟比洛芬酯注射液50 mg+注射用盐酸托烷司琼10 mg+0.9％氯化钠注射液稀释至100 mL。观察3组患者的手术时间及术中用药情况（硬膜外腔追加罗哌卡因次数和麻黄碱、阿托品使用次数）、镇痛泵有效按压次数、PCIA镇痛效果；术后2、6、12、24、48 h的视觉模拟量表（VAS）评分及Ramsay镇静评分；术前及术后焦虑抑郁量表（HAD）评分和心境量表（POMS）评分；不良反应发生情况。结果：3组患者手术时间、硬膜外腔追加罗哌卡因次数、麻黄碱及阿托品使用次数比较，差异均无统计学意义（P＞0.05）。KH组患者镇痛泵有效按压次数显著少于SF组和H组，PCIA镇痛效果优、良的比例均显著高于SF组和H组（P＜0.05），而SF组与H组比较差异均无统计学意义（P＞0.05）。3组患者术后48 h VAS评分均显著低于同组术后6、12、24 h，且KH组同时点评分均显著低于SF组、H组（P＜0.05），而SF组与H组比较差异均无统计学意义（P＞0.05）。3组患者术后不同时点的Ramsay镇静评分比较，差异均无统计学意义（P＞0.05）。术前，3组患者HAD评分、POMS评分比较，差异均无统计学意义（P＞0.05）；术后，KH组、H组患者HAD评分、POMS评分均显著低于同组术前及SF组（P＜0.05），而KH组与H组比较及SF组术前与术后比较差异均无统计学意义（P＞0.05）。3组患者均无呕吐、呼吸抑制、皮肤瘙痒及消化道出血发生；KH组和H组患者恶心、眩晕发生率均显著低于SF组（P＜0.05），而KH组与H组比较差异均无统计学意义（P＞0.05）。结论：氟比洛芬酯联合氢吗啡酮用于骨科术后PCIA的镇痛、镇静效果较好，可明显改善患者的情绪和心境，且安全性较好。 |
| ABSTRACT： | OBJECTIVE： To observe analgesia， sedation effects and safety of flurbiprofen axetil combined with hydromorphone for postoperative patient-controlled intravenous analgesia （PCIA） after orthopedics surgery. METHODS： Totally 90 patients with combined spinal epidural anesthesia underwent lower limb surgery were selected from anesthesology department in the Affiliated Hospital of Chengde Medical College during May 2016-Jan. 2018. They were divided into SF group， H group and KH group according random number table， with 30 cases in each group. The postoperative PCIA pump drug liquid formula of SF group included Sufentanil citrate injection 2-3 μg/kg+Tropisetron hydrochloride for injection 10 mg+0.9％ Sodium chloride injection diluted to 100 mL； that of H group included Hydromorphone hydrochloride injection 0.12 mg/kg+Tropisetron hydrochloride for injection 10 mg+0.9％ Sodium chloride injection diluted to 100 mL； that of KH group included Hydromorphone hydrochloride injection 0.12 mg/kg+Flurbiprofen axetil injection 50 mg+Tropisetron hydrochloride for injection 10 mg+0.9％ Sodium chloride injection diluted to 100 mL. The operation time， intraoperative medication （epidural application frequency of additional ropivacaine， frequency of ephedrine and atropine）， effective pressing times of analgesic pump and the analgesic effect of PCIA were observed in 3 groups. VAS score and Ramsay sedation score were observed 2， 6， 12， 24， 48 h after surgery. The hospital anxiety and depression scale （HAD） score， profile of mood states （POMS） score and the occurrence of ADR were observed before and after surgery. RESULTS： There was no statistical significance in operation time， epidural application frequency of additional ropivacaine or frequency of ephedrine and atropine among 3 groups （P＞0.05）. The effective pressing times of analgesic pump in KH group were significantly lower than SF group and H group. The proportion of patients with excellent and good anesthesia effect in KH group was significantly higher than SF group and H group （P＜0.05）； there was no statistical significance between SF group and H group （P＞0.05）. VAS score of 3 groups 48 h after surgery were significantly lower than 6， 12， 24 h after surgery； that of KH group was significantly lower than SF group and H group （P＜0.05）； there was no statistical significance between SF group and H group （P＞0.05）. There was no statistical significance in Ramsay score among 3 groups at different time points （P＞0.05）. Before surgery， there was no statistical significance in HAD score or POMS score among 3 groups （P＞0.05）. After surgery， HAD score and POMS score of KH group and H group were significantly lower than before surgery and SF group （P＜0.05）； there was no statistical significance in KH group and H group， before and after surgery in SF group （P＞0.05）. No vomiting， respiratory depression， pruritus and digestive tract bleeding were observed in 3 groups. The incidence of dizziness and nausea in H group and KH group were significantly lower than SF group （P＜0.05）； there was no statistical significance between KH group and H group （P＞0.05）. CONCLUSIONS： The flurbiprofen axetil combined with hydromorphone show good analgesic and sedative effect for PCIA after orthopedics operation， and can significantly improve emotion and mood of patients with good safety. |
| 期刊： | 2018年第29卷第20期 |
| 作者： | 曹雪峰，刘旭东，李艳，赵亮，常韬，郭淑娟，刘玉伶 |
| AUTHORS： | CAO Xuefeng，LIU Xudong，LI Yan，ZHAO Liang，CHANG Tao，GUO Shujuan， LIU Yuling |
| 关键字： | 骨科手术；静脉自控镇痛；氢吗啡酮；氟比洛芬酯；镇痛；镇静；安全性 |
| KEYWORDS： | Orthopedics surgery； Patient-controlled intravenous analgesia； Hydromorphone； Flurbiprofen axetil； Analgesia； Sedation； Safety |
| 阅读数： | 833 次 |
| 本月下载数： | 8 次 |
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