氟比洛芬酯不同给药方式行超前镇痛对阑尾切除术后患者的影响

摘要

Objective:To study the pre-emptive analgesia effects of the fluriprofen axetil using different injection ways on postoperative pain and the level of serum β-endorphin (β-EP)of appendectomy patients .Methods: Eighty ASA Ⅰ-Ⅱ patients undergoing appendectomy were randomly assigned to four groups (n=20): group A(receive fluriprofen axetil 100 mg 15min before skin cutting);group B(receive fluriprofen axetil 100mg at the end of operation);group C (receive fluriprofen axetil 50mg 15min before skin cutting and receive the remaining 50mg at the end of operation);group D (control group without pre-emptive analgesia but normal saline). All patients did not receive postoperative analgesia with patient controlled analgesia.The analgesic effect was evaluated by VAS score at 0,1,4,8,12 and 24 hours after operation.The level of serum β-EP was measured by radio-immunoassay.Results: VAS scores of group B and group D were significantly higher than those of group A and group C at 0,1,4h points (all P<0.01).But group A have no statistics diference compared with group C(all P>0.05),and group B have no statistics diference compared with Group D(all P>0.05).In group B and group D,the level of serum β-EP was significantly increased after operation,which was significantly different compared with group A and group C (all P<0.01).Conclusion:Pre-emptive analgesia with fluriprofen axetil can provide effective pain relief and can better inhibit stress and declination of cellular immunity function on postoperative patients.%目的:观察氟比洛芬酯不同给药方式对术后患者镇痛效果和血浆β-内啡肽浓度的影响.方法:将80例择期行阑尾切除术的ASAⅠ～Ⅱ级患者随机分为4组(n=20).镇痛给药方法:A组患者手术切皮前15min静脉给予氟比洛芬酯100mg;B组手术结束缝皮时静脉给予氟比洛芬酯100mg；C组手术切皮前15min和手术结束缝皮时分别静脉给予氟比洛芬酯50mg;D组手术切皮前15min静脉注射等量生理盐水.4组术后均不进行自控镇痛.分别记录术后0、1、4、8、12、24h的视觉模拟评分(VAS),并且于术前、术毕时、术后12、24h抽取外周静脉血,采用放射免疫分析法测定患者血浆β-内啡肽浓度.结果:术后0、1、4h VAS评分A、C组均显著低于B、D组(均P＜0.01),但A、C组,B、D组间比较无显著性差异(均P＞0.05)；术后8、12、24h VAS评分4组间比较均无显著性差异(均P＞0.05).B、D组术后血浆β-内啡肽浓度与A、C组比较显著升高(均P＜0.01).结论:以氟比洛芬酯行超前镇痛能够有效减轻患者术后疼痛并且减少术后患者血浆β-内啡肽的生成,抑制应激反应.