氟比洛芬酯在经直肠超声引导前列腺穿刺疼痛控制中的应用

摘要

目的:探索氟比洛芬酯静脉应用能否减轻经直肠超声引导下前列腺穿刺引起的疼痛.方法:采用随机、对照研究方法,共入选81例于北京大学人民医院泌尿外科住院行经直肠超声引导下前列腺穿刺患者,随机分为3组 (每组27例), 分别是: 直肠内局部表面麻醉 (intrarectal local anesthesia,IRLA) 组:术前5 min 5% (0.05 g/L)利多卡因凝胶60 mg直肠内局部表面麻醉;氟比洛芬酯 (flurbiprofen axetil,FA) 组:术前1 h氟比洛芬酯静脉滴注 (1 mg/kg);IRLA+FA组 :术前5 min 5% 利多卡因凝胶60 mg直肠内局部表面麻醉,同时术前1 h氟比洛芬酯静脉滴注 (1 mg/kg).使用视觉模拟评分表 (visual analogue scale,VAS) 评估超声探头插入肛门时 (VASⅠ)、 麻醉过程中 (VASⅡ)、 穿刺活检时 (VASⅢ)及术后20 min时(VASⅣ)的疼痛评分.使用单因素协方差分析比较3组间患者基线差异.疼痛评分的组间差异采用参数检验的单因素协方差分析.随后采用图基(Tukey)事后检验法进行各组间比较:P1 、P2、P3分别为IRLA组和FA组、 FA组和IRLA+FA组、IRLA组和IRLA +FA组的组间差异P值,P<0.05认为差异有统计学意义,其中组间两两比较采用Bonferroni方法调整检验水准 α=0.017.结果:所有患者未见严重的术后并发症.3组患者的基线数据差异无统计学意义, VASⅡ(5.7±2.2,3.0±1.5,3.3±1.9, P=0.012) 和 VASⅢ(6.7±2.3,3.0±2.1,2.9±1.6,P=0.001) 差异有统计学意义;VASⅠ(3.2±1.0,4.1±2.1,4.2±1.7,P=5.752)和 VASⅣ (1.4±2.1,1.0±0.9,1.1±0.7,P=3.772)差异无统计学意义.两两组间差异,在VASⅣ(P1 =0.007,P2=5.655,P3=0.001)和VASⅢ(P1 =0.008,P2=7.517,P3=0.001)方面,IRLA组和FA组、IRLA组和IRLA+FA组的组间差异有统计学意义.结论:氟比洛芬酯能安全、有效地减轻经直肠超声引导下的前列腺穿刺术患者的疼痛.%Objective: To examine the effects of perioperative intravenous administration of flurbiprofen axetil (FA) on pain associated with transrectal ultrasound-guided prostate biopsy.Methods: This was a randomized,controlled study.Eighty-one patients who underwent 12 core prostate biopsy were included in the study.The patients were randomly assigned to one of three groups (n=27 in each) by type of procedure during prostate biopsy.Group intrarectal local anesthesia (IRLA) received intrarectal 5% (0.05 g/L) lidocaine gel 60 mg, 5 minutes before the procedure alone;Group FA received intravenous flurbiprofen axetil (1 mg/kg) 1 hour before the procedure;Group IRLA+FA received intrarectal 5% lidocaine gel 60 mg, 5 minutes before the procedure and intravenous flurbiprofen axetil (1 mg/kg) 1 hour before the procedure.The patients were asked to score the pain by using visual analogue scale (VAS) in 4 situations,including when the probe was inserted (VASⅠ),during anesthesia (VASⅡ),during biopsy (VASⅢ) and 20 minutes after biopsy (VASⅣ).The findings were evaluated with analysis of variance,and the Tukey post hoc test was followed with an overall 2-tailed significance level at α =0.05.P1, P value between Group IRLA and Group FA;P2, P value between Group FA and Group IRLA +FA,P3, P value between Group IRLA and Group IRLA +FA.The bonferroni method was used to adjust the test level, α=0.017,a P value of less than 0.017 was accepted as the threshold for statistical significance.Results: No major complications,including sepsis and severe rectal bleeding,were noted in any patient.There were no differences in general condition of the patients before procedure among the 3 groups.There were statistically significant differences in VAS scores among the 3 groups in VASⅡ (5.7±2.2, 3.0±1.5,3.3±1.9,respectively,P=0.012) and VASⅢ (6.7±2.3,3.0±2.1,2.9±1.6,respectively,P=0.001).There were no differences in the pain scores among the 3 groups during probe insertion (VASⅠ, 3.2±1.0,4.1±2.1,4.2±1.7, respectively,P=5.752) and 20 minutes after biopsy (VASⅣ, 1.4±2.1,1.0±0.9,1.1±0.7,respectively,P=3.772).Between-column differences among the 3 groups were VASⅡ (P1=0.007,P2=5.655,P3=0.001,respectively) and VASⅢ(P1=0.008,P2=7.517,P3=0.001,respectively),the differences between Group IRLA and Group FA,Group IRLA and Group IRLA +FA in VASⅡ and VASⅢ were statistically significant.Conclusion:The intravenous flurbiprofen axetil was found to be more effective than intrarectal lidocaine gel alone.