氟比洛芬酯对宫颈癌根治术后舒芬太尼静脉镇痛的影响

摘要

目的:观察氟比洛芬酯与舒芬太尼合用对宫颈癌根治术后静脉镇痛的效果、肠道功能恢复及围术期应激反应的影响.方法:将宫颈癌根治术患者90例均分为3组.A组术后静脉镇痛舒芬太尼2 μg/kg+氟比洛芬酯200 mg.B组舒芬太尼4 μg/kg.C组舒芬太尼2μg/kg.3组均用生理盐水稀释至100 mL,3组维持量2 mL/h.单次负荷剂量1 mL,锁定时间15 min.采用视觉模拟评分(VAS)记录3组术后6、12、24、48 h疼痛评分:用ELISA法测定术前、术后24 h、72 h细胞因子IL-6和TNF-a值,记录胃肠功能恢复时间.结果:术后各时间点C组VAS评分高于A组和B组(PA,C＜0.05,PB.C＜0.05).A组B组镇痛效果良好,两组VAS评分差异没有显著性(PA.B＞0.05).A组患者肠鸣音恢复时间比B组和C组的时间短,B、C组患者肠鸣音恢复时间差异无显著性(PA,B＜0.05,PA,c＜0.05,PB,C＞0.05).A组肛门排气时间比B组和C组的时间短,B、C组患者肛门排气时间差异无显著性(PA,B＜0.05,PA,C＜0.05,PB,C＞0.05).术后各组IL-6和TNF-a值相比术前水平明显升高.术后24 h、72 h A组IL-6和TNF-a值均低于B组和C组(PA,B＜0.05,PA,C＜0.05).结论:氟比洛芬酯联合使用舒芬太尼镇痛效果良好,可显著减少舒芬太尼的用量从而使肠道功能恢复时间缩短,减轻围术期的炎性反应.%Objective To evaluate the analgesia effect of intravenous infusion of flurbiprofen axetil and sufentanyl on patients after radical hysterectomy for cervical cancer, and their effects on bowel function and stress reaction in these patients. Method Ninety patients undergoing radical hysterectomy for cervical cancer were randomized into 3 groups, patients in Group A received sufentanyl (2 μg/kg) plus flurbiprofen axetil (200 mg), patients in Group B received 4 μg/kg of sufentanyl, and those in Group C received 2 μg/kg of sufentanyl. All the drugs were diluted with 100 mL of normal saline , the priming dose was 1 mL, and then the drugs were delivered at the rate of 2 mL/h, and the lock time was 15 min. At 6 h, 12 h, 48 h, 72 h after operation, the analgesic effect was evaluated by Visual Analogue Scale (VAS), the recovery time of gastrointestinal function was recorded, and the levels of TNF-α and IL-6 were measured by ELISA at 30 min before and 24 h and 72 h after the operation. Results VAS score in Group C was higher than those in Group A and B at each time spot (P < 0.05). There were no significant differences of VAS score between Group A and B (P > 0.05). The time intervals from surgery to the first bowel movement were shorter in Group A than those in Group B and C (P < 0.05). The time intervals from surgery to the first flatus was also shorter in Group A than those in Group B and C (P < 0.05). Group B and Group C showed similar time of gastrointestinal function recovery after operation (P > 0.05). The levels of IL-6 and TNF-a were increased after surgery, and those were lower in Group A as compared to Group B and C at 24 h and 72 h after surgery (P < 0.05). Conclusion Flurbiprofen axetil combined with sufentanil for postoperative analgesia can significantly reduce the dose of sufentanyl, and facilitate the recovery of bowel function and attenuated the cytokine response.