目的：比较氟比洛芬酯、舒芬太尼、高乌甲素复合曲马多用于腹腔镜胆囊切除术后静脉镇痛对凝血功能的影响和安全

性。方法：180 例腹腔镜胆囊切除术后给予静脉镇痛患者随机均分为F 组、S 组和L组。所有患者术毕即刻接静脉电子镇痛泵，F

组患者给予氟比洛芬酯注射液150 mg，S 组患者给予舒芬太尼注射液100 μg，L组患者给予高乌甲素注射液24 mg。各组均复合

盐酸曲马多注射液进行自控静脉镇痛。观察各组患者术毕及术后4、8、16、24、36、48 h 的视觉模拟（VAS）评分，术前（T0）、术毕

（T1）、术后第1 天（T2）、术后第2 天（T3）的血小板计数（PLT）、血小板平均体积（MPV）、凝血酶原时间（PT）、活化部分凝血活酶时间

（APTT）、国际标准化比值（INR）及不良反应发生情况。结果：F、S组患者术后4、8、16 h 的VAS评分均显著低于同组术毕时和L组

同期，差异均有统计学意义（P＜0.05），但F、S组间比较差异均无统计学意义（P＞0.05）；各组患者T1、T2、T3时PLT显著低于同组T0

时，PT、APTT均显著高于同组T0时，S组患者T2时MPV均显著高于同组T0、T1时，L组患者T2、T3时MPV均显著高于同组T0、T1时，

F、S 组患者T1、T2、T3时及L 组患者T1时INR 均显著高于同组T0时，差异均有统计学意义（P＜0.05），但各组间及F 组患者各时点

MPV比较，差异均无统计学意义（P＞0.05）。F组患者不良反应发生率显著低于S组和L组，差异均有统计学意义（P＜0.05），但S、

L组间比较差异无统计学意义（P＞0.05）。结论：氟比洛芬酯、舒芬太尼、高乌甲素复合曲马多均可用于腹腔镜胆囊切除术后静脉

镇痛，可降低血小板数量，抑制高凝状态，而无出血倾向，但氟比洛芬酯复合曲马多安全性较好。

OBJECTIVE：To compare the blood coagulation and safety of flurbiprofen axetil，sufentany and lappaconitine combined

with tramadol for postoperative intravenous analgesia in laparoscopic cholecystectomy. METHODS：180 patients who required

intravenous analgesia after laparoscopic cholecystectomy were randomly divided into flurbiprofen axetil group（F），sufentany group

（S）and lappaconitine group（L）. All patients received intravenous electronic analgesia pump after intravenous anesthesia. Patients

in group F were given 150 mg Flurbiprofen axetil injection；group S was given 100 ug Sufentany injection；and group L was given

24 mg Lappaconitine injection. Tramadol hydrochloride injection was used in each group for self-test of intravenous analgesia. VAS

at the end of surgery and 4，8，16，24，36 and 48 h after surgery，PLT，MPV，PT，APTT，INR and ADR before surgery（T0），the

end of surgery（T1），the first day（T2）and second day（T3）after surgery in 3 groups were observed. RESULTS：VAS scores after

4，8 and 16 h in group F and group S were significantly lower than the end of surgery and both group F and group S were lower

than group L（P＜0.05），however，there was no significant difference between group F and group S（P＞0.05）；when PLT were significantly

lower than T0，PT and APTT at T1，T2 and T3 were significantly higher than T0，MPV in group S at T2 was significantly

higher than T0，T1 and T3，MPV in group L at T2 and T3 was significantly higher than T0 and T1，INR in group F and group S at

T1，T2 and T3 and group L at T1 was significantly higher than T0（P＜0.05），and there was no significant difference in the MPV

among 3 groups and group F at different time points（P＞0.05）. The incidence of adverse reactions in group F was significantly lower

than group S and group L（P＜0.05），however，there was no significant difference between group S and group L（P＞0.05）.

CONCLUSIONS：Flurbiprofen axetil，sufentany and lappaconitine combined with tramadol can be used for postoperative intravenous

analgesia in laparoscopic cholecystectomy，reduce the number of platelets，inhibite hypercoagulable state and prolong coagulation

without bleeding tendency. But flurbiprofen axetil combined with tramadol has better safety.