氟比洛芬酯预防瑞芬太尼复合麻醉术后急性疼痛_医学论文.docVIP

氟比洛芬酯预防瑞芬太尼复合麻醉术后急性疼痛_医学论文 氟比洛芬酯预防瑞芬太尼复合麻醉术后急性疼痛_医学论文 作者：宗志军，潘道波，曾因明，杨柳，吴雪峰 【摘要】 目的 研究氟比洛芬酯防治瑞芬太尼复合麻醉术后急性疼痛的临床疗效。方法 骨科脊柱手术患者40例，随机分为氟比洛芬酯组（FA组）和对照组，每组20例。FA组于手术缝合皮肤前约20～30 min静脉注射氟比洛芬酯（1 mg/kg），对照组注射0.9%NS(0.1 ml/kg)。所有患者在手术结束时停止泵注异丙酚和瑞芬太尼。比较2组患者自主呼吸恢复、意识恢复和拔管时间以及患者恢复期的疼痛程度和拔管后需要追加芬太尼的例数。结果 FA组和对照组患者的自主呼吸恢复时间、意识恢复时间和拔管时间差异不明显（Pgt0.05）。但FA组停止瑞芬太尼后发生急性中等和严重疼痛的例数明显少于对照组,且拔管后需要追加芬太尼的人数也远远少于对照组(0．05)。结论 手术结束前20～30 min静脉注射氟比洛芬酯能够防治停止麻醉后因瑞芬太尼的快速代谢而引起的术后急性疼痛, 而且不影响自主呼吸恢复和意识恢复。 【关键词】 氟比洛芬酯瑞芬太尼全身麻醉镇痛 　　Abstract：Objective To investigate the postoperative analgesic effect of flurbiprofen axetil (FA) used in remifentanil-based anesthesia with propofol．Methods Forty patients undergoing major spine surgery were randomly assigned to a FA group and a control group to receive FA 1 mg／kg iv and 0.9% NS 0.1 ml/kg iv respectively 20-30 min before the end of operation, with remifentanil and propofol switched off after skin closure． The time to resumption of spontaneous respiration， eye opening and extubation were recorded. Pain was evaluated and the number of patients who needed a second dose of pain killer (such as fentanil) was recorded．Results There were no significant differences in the time to resumption of spontaneous respiration， eye opening or extubation between the two groups． Much fewer patients had moderate-to-severe pain or required a second dose of fentanil after extubation in the FA group than in the control group (15% vs.90%, 0.01)．Conclusion Intraoperative administration of FA 1 mg／kg 20-30 min before the end of operation can provide immediate postoperative pain relief without causing significant effects on recovery time from remifentanil-based anesthesia． Key words: flurbiprofen axetil；remifentanil；general anesthesia；analgesia 瑞芬太尼凭借其起效快、清除快和长时间输注无蓄积等特点在临床上得到了广泛使用［1］。但因其快速代谢的特点，瑞芬太尼复合麻醉在麻醉停止后镇痛效应会迅速消失，导致明显的术后疼痛，长时间输注甚至会引起痛阈降低和痛觉过敏，且在患者感到疼痛后处理非常困难，因此应在疼痛出现前早做防范［2］。而大量研究表明氟比洛芬酯具有较强的镇痛作用［3］，无呼吸抑制作用，安全范围大。为此，本研究观察了手术结束前20～30 min静脉注射氟比洛芬酯(1 mg／kg)在骨科脊柱手术中防治瑞芬太尼停止输注后引