氯诺昔康预先镇痛对妇科术后吗啡硬膜外自控镇痛的影响  

Preemptive Analgesic Effects of Lornoxicam on Patient-Controlled Epidural Analgesia with Morphine in Gynaecological Patients

作　　者：黄焕森[1] 王卓丹[1] 吴伟玲[1] 高崇荣[1] 

机构地区：[1]广州医学院第二附属医院麻醉科,广州510260

出　　处：《热带医学杂志》2006年第8期948-949,921,共3页Journal of Tropical Medicine

摘　　要：目的探讨氯诺昔康静脉预先镇痛对妇科手术病人吗啡硬膜外自控镇痛(PCEA)的影响。方法开腹全子宫切除患者52例,ASAⅠ～Ⅱ级,随机分实验组和对照组,各26例。实验组在开腹前和关腹前分别静脉注射氯诺昔康8mg。两组PCEA均为0.01%吗啡与0.125%布比卡因混合液配方。用法:负荷量5ml,背景量1.5ml/h,PCA量3ml,锁定时间20min。观察指标:镇痛效果使用VAS评分法,记录术后1、2、4、8、12、24、36、48h病人疼痛评分,术后第1、2天的PCA按压次数(PCAC)。副反应:病人镇静、头晕、恶心、呕吐等情况。结果实验组术后12h内的疼痛评分低于对照组(P﹤0.05),24、36、48h两组差别不明显(P>0.05)。术后第1天实验组PCAC明显少于对照组(P﹤0.05)。副作用:实验组恶心、呕吐发生率(15.3%)低于对照组(38.4%)。结论氯诺昔康预先镇痛对妇科手术病人术后吗啡自控镇痛有明显增效作用,减少了PCEA过程的吗啡用药量,以及胃肠道副作用的发生率。Objective To determine the preemptive analgesic effects of lomoxicam on patient-controlled epidural analgesia （PCEA） with morphine in patients received gynaecological surgery. Method 52 patients of ASA physical status Ⅰ -Ⅱ undergoing abdominal hysterectomy were randomly divided into two groups：Study group （n=26） and control group （n=26）. Patients in study group received intravenous lomoxicam 8mg before incision and suture. Patients in beth groups were given patient-controlled epidural analgesia with 0.01% morphine and 0.125% bupivacaine in normal saline. PCEA recipe： loading dose 5ml, continuous infusion 1.5 ml/h,PCA bolus 3 ml, lockout time 20 min. Visual analogue scale（VAS） of 1, 2, 4, 8, 12,24,36,and 48 h were recorded. Pressing times （PCAc） were also recorded for 48 hours and complications such as sedation, dizziness, nausea and vomiting were observed. Result VAS after 12 h were lower in study group than that in control group （P〈 0.05）.The differences of VAS after 24,36,48 h between the two groups were not significant （P〉 0.05）. PCAc of the first day in study group was much lower than that in the control group. The rates of nausea and vomiting were 15.3% in study group and 38.4% in control group. Conclusion Preemptive lomoxicam can obviously improve the analgesic effects of PCEA with morphine in patients received gynaecological surgery. The consumption of morphine and the incidence of nausea and vomiting can be decreased.

关 键 词：氯诺昔康 预先镇痛 吗啡 自控镇痛 

分 类 号：R969.4[医药卫生—药理学]