古小玲　古汉南　陈瑶　杨楚凤　郭志刚　李木卫　张子清

【摘要】 目的：探討氟比洛芬酯与曲马多注射液对断指再植术后镇痛的临床疗效以及不良反应发生情况。方法：收集本院2014年4月-2015月10月85例断指再植术患者，按照随机数字表法分为两组，除常规治疗外，A组使用氟比洛芬酯注射液，B组使用曲马多注射液，观察比较分析术后48 h两组患者不同时间疼痛程度、药物不良反应、断指再植指体血管危象发生率、存活率、药物费用等指标。结果：两组术后3、6、12 h VAS评分比较，差异均有统计学意义（P<0.05）；A组存活率100%，B组存活率97.5%（P>0.05）；两组血管危象发生率比较，差异均无统计学意义（P>0.05）；A组不良反应发生率为2.2%，B组为17.8%，两组比较差异有统计学意义（P<0.05）；A组术后镇痛药物费用显著高于B组（P<0.05）。结论：在等剂量、给药方法相同情况下，氟比洛芬酯比曲马多有较强的预防断指再植术后引起的疼痛，能明显降低眩晕、恶心、呕吐等药物不良反应，并可减少阿片类药物的使用和不良反应发生，临床安全性好，但费用较高，对断指再植成活率的影响不显著。

【关键词】 氟比洛芬酯； 曲马多； 断指再植； 术后镇痛； 不良反应

Analgesia Effect Analysis on Flurbiprofen and Tramadol for Finger Replantation/GU Xiao-ling，GU Han-nan，CHEN Yao，et al.//Medical Innovation of China，2017，14（14）：039-042

【Abstract】 Objective：To explore the analgesia effect and clinical reactions of Flurbiprofen and Tramadol in the finger replantation operations.Method：From April 2014 to October 2015，a total of 85 finger replantation cases were collected and subsequently grouped into two groups，Group A was treated with Flurbiprofen and Group B was treated with Tramadol Injection including the routine medical solutions.48-hour observations were seriously in record，including the pain，the medical reaction status，the occurrence of vascular crisis of the replanted fingers，the rate of survival of replantation and medical cost，etc.Result：Based on the observation made 1，3，6，12，24，48 h respectively after the operation，statistics were collected and difference was statistically significant（P<0.05）.The survival rate of Group A and Group B were respectively 100% and 97.5%（P>0.05）.The occurrence of vascular crisis indicated no statistical significance（P>0.05），while the adverse reaction rate of Group A and Group B were 2.2% and 17.8% respectively.The variance of two groups on drug adverse reactions had statistical significance（P<0.05）.The medical cost of Group A was substantially higher than that of Group B（P<0.05）.Conclusion：With the same dose of drug use and medication，the use of Flurbiprofen has much better effect to prevent the pain caused by finger replantation and can subsequently reduce the occurrence of adverse drug reactions，such as dizziness，nausea，vomiting，etc.Despite the higher medical costs，a higher rate of clinical safety is observed and no impact on the replantation survival was found.

【Key words】 Flurbiprofen； Tramadol； Finger replantation； Analgesia； Adverse reaction

First-authors address： Longgang District Orthopaedics Hospital of Shenzhen ，Shenzhen 518116，China

doi：10.3969/j.issn.1674-4985.2017.14.011

自1963年，我国医学前辈陈中伟等[1]对一例全部离断的肢体进行再植并获得成功，术后再植手运动能力恢复较为满意。这一“标志性事件”在外科发展中创立了现代再植外科的这一新学科，时至今日现代再植外科已有五十多年的繁荣发展历史[2]。断指再植的成活率伴随着临床科学技术的发展进步及多种新型医疗材料的应用而逐漸增高，虽然中国有学者报告的断指再植成活率可以达到96%～97.8%非常高的水平[3-5]，但目前还是有许多的并未取得满意结果的断指再植的失败病例被报告。断指再植术后发生的血管危象是影响断指再植最终能否获得成功的一个十分重要因素[6]，而术后疼痛又是诱发血管痉挛，造成血管危象发生，影响再植成功的主要因素之一[7]，疼痛可加剧患者紧张、恐惧、焦虑等情绪，诱发血管危象，影响再植指体的成活。因……