学术论文

      不同剂量纳布啡联合氟比洛芬酯多模式镇痛用于开胸术后自控镇痛效果和安全性研究

      Efficacy and safety research of multimodal analgesia with different doses of nalbuphine combined with flurbiprofen in intravenous patient -controlled analgesia after thoracotomy

      摘要:
      目的:评价不同剂量纳布啡联合氟比洛芬酯多模式镇痛用于开胸术后自控镇痛的效果和安全性。方法择期在全麻下行开胸手术患者60例,ASA Ⅰ~Ⅱ级,年龄18~65岁,进入该研究,接受术后患者静脉自控镇痛(PCIA),按照随机数字表法分为三组,分别为纳布啡60 mg(N60)组,纳布啡80 mg(N80)组和纳布啡100 mg(N100)组,每组20例,均复合150 mg 氟比洛芬酯,总量为100 mL。PCIA 方案:背景剂量为2 mL/h,PCIA 剂量0.5 mL,锁定时间15 min。每例患者手术开始前10 min 均缓慢静脉注射氟比洛芬酯50 mg,关胸时给予负荷量0.1 mL/kg。术后随访至48 h。记录生命体征,患者按压次数,VAS 评分,镇静评分以及恶心呕吐等不良反应发生情况。结果三组间一般情况差异均无统计学意义(均 P >0.05),术后48 h内生命体征基本平稳。术后4、6、8、24 h 和48 h,N80组(t =7.94、6.35、6.49、5.21、5.63,均 P =0.00)和 N100组(t =8.41、9.10、5.80、8.07、8.18,均 P =0.00)的 VAS 评分显著低于 N60组(均 P <0.05),N80组与 N100组除 N80组术后48 h 的 VAS 评分低于 N100组(t =2.30,P =0.03)外,差异无统计学意义;N80组和 N100组的 PCIA 有效/实际按压次数比显著高于 N60组(t =7.30、8.35,均 P <0.05)。三组嗜睡、恶心、呕吐等不良反应的发生率差异无统计学意义(N80组与 N60组相比:χ2=0.17、0.23、1.03,均 P >0.05;N100组与 N60组相比:χ2=3.14、0.23、1.03,均P >0.05)。结论纳布啡80 mg 复合氟比洛芬酯150 mg 应用于开胸术后自控镇痛效果满意,用药成本更低。
      Abstract:
      Objective To assess the efficacy and safety of multimodal analgesia with different doses of nalbuphine combined with flurbiprofen on patients who received intravenous patient -controlled analgesia(PCIA) after thoracotomy.Methods Sixty patients underwent thoracotomy,ASA Ⅰ -Ⅱ,18 -65 years old,who underwent postoperative PCIA,were randomly divideded into three groups according to the digital table,nalbuphine 60 mg group (N60 group),nalbuphine 80 mg group(N80 group)and nalbuphine 100 mg group (N100 group),20 cases in each group.All patients were given 150mg flurbiprofen,a total of 100mL.PCIA solution:the background dose was 2mL/h, PCIA dose of 0.5mL,locking time of 15min.10min before surgery,each patient was intravenously given flurbiprofen 50mg,given a loading dose of 0.1mL/kg when closed chest.All patients were followed up for 48h.The incidence of adverse reactions such as vital signs,number of times,visual analog scale(VAS)score,sedation score,nausea and vomiting were recorded.Results There were no significant differences in the age,gender,body mass index and surgery duration among the three groups(all P >0.05).The vital signs were stable within 48h after operation.The VAS scores of N60 group were higher than the other two groups(N80 group:t =7.94,6.35,6.49,5.21,5.63,all P =0.00;N100 group:t =8.41,9.10,5.80,8.07,8.18,all P =0.00)at 4,6,8,24 and 48h after operation(all P <0.05).The VAS score of N80 group 48 h after operation was lower than that of N100 group(t =2.30,P =0.03),and&nbsp;the difference was not statistically significant in remaining(all P >0.05).The effective /actual compression ratio of PCIA of N80 group and N100 group were significantly higher than that of N60 group (t =7.30,8.35,all P <0.05). There were no differences in the incidence of adverse reaction among the three groups(group N80:χ2 =0.17,0.23, 1.03,all P >0.05;group N100:χ2 =3.14,0.23,1.03,all P >0.05).Conclusion Postoperative PCIA with nalbu-phine (80 mg)combined with flurbiprofen(150 mg)has significant analgesic effect and lower costs.
      Author: Qi Zhong Xiao Xiaoqin Wang Jiafang Zhu Degang Zhu Bin
      作者单位: 华中科技大学附属中西医结合医院 武汉市第一医院麻醉科, 湖北省武汉,430020
      刊 名: 中国基层医药 ISTIC
      年,卷(期): 2017, 24(6)
      在线出版日期: 2017年3月29日