张劲军　徐康清　罗文颖　魏　明　黄文起

【摘要】 目的 观察氟比洛芬酯复合小剂量吗啡用于开胸手术术后静脉镇痛的效果和安全性。方法 60例开胸手术患者，随机分成两组（F、M组），每组30例，术毕接电子泵行静脉自控镇痛(PCIA)。F组手术结束前15 min静脉注射氟比洛芬酯50 mg+吗啡3 mg为首量，维持配方为吗啡24 mg+氟比洛芬酯300 mg+生理盐水共150 ml，背景流量2 ml /hr，单次剂量3 ml ，锁定时间30 min。M组在相同时间点给吗啡3 mg为首量，维持配方为吗啡60 mg+生理盐水共150 ml，参数同F组。分别记录和统计手术后12、48 h各时间点两组患者的视觉模拟疼痛评分(VAS)、镇静评分(Ramsay评分)、泵按压次数、伤口引流量及恶心、呕吐、瘙痒、呼吸抑制、消化道出血等不良反应的发生率。结果 两组镇痛效果相近，VAS评分和48 h伤口引流量组间比较，差异无统计学意义(P>0．05)，F组镇静评分、恶心、呕吐、瘙痒发生率低于M组,组间比较，差异有统计学意义(P<0．05)。M组有1例呼吸抑制，F组无呼吸抑制。两组均未见消化道出血。结论 氟比洛芬酯复合小剂量吗啡用于开胸手术术后静脉镇痛，疗效确切，不良反应少，安全性高。

【关键词】氟比洛芬酯;术后静脉镇痛；吗啡；开胸手术

Observation for flurbiprofen axetil combined with low dose morphine using on intravenous postoperative analgesia after thoracic surgery

ZHANG Jin-jun, XU Kang-qing，LUO Wen-ying, et al.Department ofAnesthesiology ,The First Affiliated Hospital of Sun Yat-sen Univesity, Guangzhou510080,China

【Abstract】 Objective To investigate the efficacy and safety of intravenous analgesia with flurbiprofen axetil combined with low dose of morphine after thoracic surgery.Methods Sixty patients were randomly divided into two groups (F and M) with 30 cases each.Patient-controlled intravenous analgesia (PCIA) was applied after surgery in both group. Group F: morphine 3 mg + flurbiprofen axetil 50 mg was given as the loading dose with the maintenance of morphine 24 mg + flurbiprofen axetil 300mg+0.9% Sodium chloride diluted to 150 ml .Group M: morphine 3 mg as the loading dose with the maintenance of morphine 60 mg+0.9% Sodium chloride diluted to 150 ml. Both loadingdose were given intravenously 15 minutes before the end of operation andcontinuous infusion rate was2 ml/h and bolus was 3ml each time and lock time was 30 minutes.The efficacy of analgesia was assessed by visual analogue pain score (VAS), sedation score (Ramsay score), the number of pumps pressing , wound drainage and the side effects such as nausea, vomiting, pruritus, respiratory depression, gastrointestinal bleeding during the period of postoperative 12 hours and 48 hours. Results The analgesic effects were similar and the VAS score and 48 hours wound drainage showed no statistical difference(P>0．05). In Group F ,the sedation score and the incidence rate of nausea, vomiting, pruritus were lower than those in group M and the differences were statistically significant(P<0．05). One case of respiratory depression occurred in group M and no respiratory depression was found in F Group. No gastrointestinal bleeding occurred in either of the two groups. Conclusion After thorax surgery, intravenous postoperative analgesia with flurbiprofen axetil combined with low dose of morphine is effective with less side effects and more safeness.

【Key words】Flurbiprofen axetil; Intravenous postoperative analgesia; Morphine; Thoracic surgery

开胸手术创伤大，术后疼痛剧烈，患者为保护性地减少呼吸幅度，致使潮气量下降，咳嗽排痰受限，容易出现术后肺炎、肺不张、缺氧等并发症，因此，术后镇痛意义显著。静脉自控镇痛是简单易行的方法，但传统单纯阿片类药物静脉镇痛常引起较多的不良反应如嗜睡、恶心、呕吐、瘙痒等，因此限制了其临床应用。氟比洛芬酯是新型的具有靶向作用的静脉非甾体消炎药，有较强的减轻创伤炎性反应和疼痛的作用，术后与吗啡复合应用，可减少吗啡用量。本文以传统单纯吗啡自控静脉镇痛作为对照，观察氟比洛芬酯复合小剂量吗啡对开胸患者的镇痛效果及安全性。