【摘要】 目的观察不同剂量的氟比洛芬酯(FP)注射液复合舒芬太尼行术后镇痛的效果及其对炎性反应的影响。方法选择112例行腰椎间盘减压融合术、胸腔镜肺叶切除术患者,随机分为FP 1组(F1组)30例、FP 2组(F2组)31例、FP 3组(F3组)25例和对照组(C组)26例。术后镇痛泵均采用双泵设置,泵1:F1、F2、F3组分别为舒芬太尼100μg+FP 1、2、3 mg.kg-1.d-1+生理盐水至100 ml;C组舒芬太尼100μg+生理盐水至100 ml,恒速泵注2 ml/h。泵2(补救镇痛,PCA输注):四组均为舒芬太尼100μg+生理盐水至100 ml,2 ml/15 min。F1、F2、F3组患者手术开始前5 min均给予FP 1 mg/kg。记录给药后24、48 h VAS评分、PCA按压次数。于给药前、给药后6、24、48 h抽取静脉血测定血清肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)浓度;F1、F2、F3组给药后6、24、48 h FP血药浓度。结果给药后24 h C组VAS评分高于F2、F3组,F1组高于F3组(P<0.05);给药后48 h C组VAS评分高于F2及F3组(P<0.05)。给药后48 h F1组PCA按压次数多于F3组(P<0.05)。给药后24 h C组ΔTNF-α高于F2、F3组(P<0.05),给药后48 h C组ΔTNF-α高于F2组(P<0.05)。给药后6、24、48 h F1、F2组FP血药浓度均低于F3组(P<0.05)。结论围手术期使用FP可明显改善患者的术后疼痛,降低VAS评分和TNFα-水平。术后静脉镇痛泵中采用舒芬太尼1μg/ml复合FP 2 mg.kg-1.d-1可以达到较为满意的镇痛效果。更多还原

【Abstract】 Objective To investigate the effects of flurbiprofen(FP) combined with sufentanil on postoperative analgesia and anti-inflammatory.Methods One hundred and twelve patients(ASA Ⅰ or Ⅱ,aged 30-70 years old),scheduled for lumbar disc decompression operation and VATS lobectomy under general anesthesia.All patients were randomly divided into four groups.Control group(group C),the other three groups were given flurbiprofen(1 mg/kg) 5 min before surgery.Pump 1 sufentanil 100 μg+different concentration FP(group C:0 and F1,F2,F3:1,2,3 mg·kg-1·d-1 respectively)+normal saline to 100 ml,base:2 ml/h;pump 2 sufentanil 100 μg+normal saline to 100 ml,PCA:2 ml/15 min.The scores of VAS and the times of requirement for PCA were recorded at 6,24 and 48 h after surgeries.The serum TNF-α,IL-6 concentration and plasma concentration of flurbiprofen were measured before flurbiprofen administration,6,24 and 48 h after administration.Results The scores of VAS in group C were higher than that in group F2 and F3,and that in group F1 were higher than group F3 in 24 h(P<0.05);the scores of VAS in group C were higher than that in group F2 and F3 in 48 h(P<0.05).The times of PCA in group F1 were more than in group F3(P<0.05)in 48 h.The value of TNF-α in group C was higher than that in group F2 and F3(P<0.05)in 24 and 48 h.Plasma concentration of flurbiprofen was higher in group F1 and in group F3(P<0.05),and group F2 was higher than that in group F3(P<0.05)at 6,24,48 h.Conclusion Perioperative using of flurbiprofen could attenuate the pain of patients,lower VAS score and decrease TNF-α levels.Postoperative intravenous analgesia with sufentanil 1 μg/ml combinded with flurbiprofen 2 mg·kg-1·d-1 can achieve satisfactory of analgesia.更多还原