氟比洛芬酯联合颈丛神经阻滞用于甲状腺癌联合根治术的超前镇痛  

Flurbiprofen axetil injection combined with bilateral cervical plexus nerve block in thyroid carcinoma surgery as multimodal preemptive analgesia

作　　者：王敬[1,2] 朱敏敏[1,2] 朱赟 曹云开[1,2] 

机构地区：[1]复旦大学附属肿瘤医院麻醉科 [2]复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中国癌症杂志》2010年第2期151-155,共5页China Oncology

摘　　要：背景与目的:超前镇痛是伤害性刺激作用于机体之前采取的一种措施,可防止神经中枢敏感化,减少和消除伤害引起的疼痛。本研究采用氟比洛芬酯联合颈丛神经阻滞用于甲状腺癌联合根治术的超前镇痛,采用多药物多途径的多模式联合超前镇痛,以尽可能消除外周和中枢敏化的形成,从而取得完善、长效的镇痛效果。方法:2009年6-8月间,选择60例择期行单侧甲状腺癌联合根治术的患者,随机分成A、B和C3组,A组:氟比洛芬酯+颈丛神经阻滞作为的联合超前镇痛;B组:颈丛神经阻滞作为超前镇痛;C组:单纯全麻组。A组术前30min及皮肤缝合毕即刻分别给氟比洛芬酯50mg稀释至20mL静脉缓慢(1min以上)推注,B、C组分别在相同时点给予生理盐水对照,A、B组均行双侧浅颈丛神经阻滞,给予0.375%罗派卡因20mL。记录A、B两组颈丛阻滞起效时间、手术时间、拔管时间以及芬太尼用量。分别于术后1、4、8、24h疼痛视觉模拟评分(visual analogue scale,VAS)(静息和活动),以及恶心呕吐、嗜睡、呼吸抑制等不良反应的发生情况。结果:在神经阻滞的起效时间上A、B组分别是(7.47±1.04)和(8.75±1.36)min,两组相比差异有统计学意义(P<0.05);术中A、B和C组芬太尼用量分别是(0.36±0.04)、(0.40±0.06)和(0.45±0.07)mg,A组与B组、A组与C组相比,差异均有统计学意义(P<0.05,P<0.01);术后疼痛视觉模拟评分方面,术后4h和8h(活动)A、B组与C组分别是(26±8)和(32±6)、(25±6)和(37±5)、(36±6)和(40±6)mm,A组与C组、B组与C组、A组与B组相比,差异均有统计学意义(P均<0.05);而术后24h(静息和活动)A、B和C组分别是(25±4)和(34±5)、(27±5)和(36±5)、(31±5)和(40±6)mm,A组与C组相比,差异有统计学意义(P<0.05)。不良反应方面,恶心呕吐发生情况A、B与C组分别是1、0和5例。结论:氟比洛芬酯联合颈丛神经阻滞用于甲状腺癌联合根治术的超前镇痛可以提供更加快速、Background and purpose：Preemptive analgesia is one of the strategies to treat postoperative pain by preventing the establishment of central sensitization. This study was designed to explore whether the method of flurbiprofen axetil injection combined with bilateral cervical plexus nerve block in thyroid carcinoma surgery as multimodal preemptive analgesia can serve as a better analgesia. Methods：Sixty patients with thyroid carcinoma were randomly divided into three groups. Patients in Group A were treated with flurbiprofen axetil injection combined with bilateral cervical plexus nerve block as multimodal preemptive analgesia. Patients in Group B were anesthetized with bilateral cervical plexus nerve block. General anesthesia alone was used in patients of Group C. The onset time of nerve block, operation time, extubation time and dosage of fentanyl were recorded. The VAS （visual analogue scale） was used to evaluate the pain level, the side effects of drugs were also analyzed. Results：The onset time of nerve block in Group A, Group B were （7.47±1.04） min and （8.75±1.36） min, repectively （P〈0.05）. The dosage of fentanyl in Group A, B and C were （0.36±0.04） mg, （0.40±0.06） mg and （0.45±0.07） mg, respectively （Group A vs Group B P〈0.05; Group A vs Group C, P〈0.01）.VAS scores of patients in Group C were higher than both Group A and B at 4,8 h after operation. Moreover, patients in Group B got higher VAS scores than that of Group A at 8 h. The side effects of both Group A and B were much less serious than that of Group C. Conclusion：Flurbiprofen axetil injection combined with bilateral cervical plexus nerve block as multimodal preemptive analgesia during thyroid carcinoma surgery can supply better analgesia and opioid-sparing effects, with less side effects.

关 键 词：超前镇痛 氟比洛芬酯 颈丛神经阻滞 多模式 不良反应 

分 类 号：R730[医药卫生—肿瘤]