[临床医学]依托考昔在脊柱外科围手术期镇痛应用课件.ppt

ES（effect size index）效应量：对疼痛缓解程度、需要补充止痛剂的数量、首次给予止痛剂时间三方面进行综合评估的结果。 * 目前，围手术期镇痛治疗常用的药物主要有阿片类药物、非选择性NSAIDs、选择性COX-2抑制剂。 阿片类药中吗啡、芬太尼、哌替啶为强阿片类药，曲马多为弱阿片类。 吗啡常用的给药方式有：口服、静脉注射、肌肉注射、患者自控镇痛； 芬太尼除了静脉注射及患者自控镇痛外还有透皮贴剂； 哌替啶的给药方式为静脉注射或肌肉注射； 曲马多作为弱阿片类药，有口服、静脉注射、肌肉注射、患者自控镇痛等多种给药途径。 临床上常用的非选择性NSAIDs主要有布洛芬、氟比洛芬酯（凯纷）、氯诺昔康（可塞风）等，其中布洛芬为口服药；氟比洛芬酯及氯诺昔康为注射制剂。 塞来昔布（西乐葆）作为选择性COX-2抑制剂，为胶囊口服剂；作为全球第一种注射用选择性COX-2抑制剂，特耐的上市无疑填补了目前选择性COX-2抑制剂无注射剂型的市场空缺，更好的满足了围手术期禁食期内不能口服给药的临床需求。 三大类药均可应用于术后疼痛治疗，那么它们是否能够从容应对骨科围手术期镇痛需求呢？下面我们就去一一揭晓答案。 * 250 patients who had undergone surgical procedures (in- and outpatient) in the past year completed a questionnaire about their experiences with pain before and after surgery. The most common concern that patients expressed prior to surgery was experiencing pain (59%), which was cited more often than concerns about whether the surgery would improve their condition (51%) or whether they would fully recover (46%). 58% of the sample reported pain prior to surgery. Despite receiving treatment for pain, 82% reported pain in the immediate postsurgical period (end of surgery up to 2 weeks after discharge) and 75% reported pain after discharge. More than two thirds of patients reported pain of moderate to severe intensity, and extreme pain was reported by 18% overall and 8% after discharge. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97:534-540. * Opioid analgesics can be associated with substantial adverse effects that may limit their utility in the hospital. Urinary retention and GI side effects such as postoperative nausea and vomiting (PONV) can delay discharge, hinder recovery, and result in additional costs to the patient and additional time for the nursing staff to manage these events. Postoperative urinary retention is associated with the use of a variety of opioids and is quite common among patients receiving morphine for postoperati