氯诺昔康行超前镇痛在妇科手术中的临床应用
The Clinical Application of Preemptive Analgesia with Lornoxicam for Patients Undergoing Gynecological Operation
摘要:
目的：研究氯诺昔康行超前镇痛用于妇科手术的镇痛作用及效果和镇痛的不良反应。方法：50例ASA(美国麻醉医师协会)I~II级择期行妇科手术的病人，随机分为两组，每组25例。在手术结束后，两组病人均安置硬膜外镇痛泵。I组(氯诺昔康行组)术前5 min静脉缓慢注射氯诺昔康0.2 mg∙kg−1，并减少镇痛液中吗啡浓度至常规的一半；II组(对照组)术前5 min静脉缓慢注射生理盐水0.2mg∙kg−1，硬膜外镇痛与I组相同。分别记录术后1、2、4、8、12、24 h的视觉模拟评分(VAS)，镇静度评分及不良反应；记录术后各观察时间点的心率、收缩压、舒张压、平均动脉压、呼吸、血氧饱和度等指标。并在镇痛结束后对病人的镇痛效果及满意度进行分析统计。结果：术后1、4、12、24时点的VAS评分I组均低于II组(P< 0.05)，两组镇痛后的不良反应有显著差异，I组好于II组。且镇痛结束后，病人对镇痛效果的满意度I组要高于II组。结论：使用氯诺昔康行妇科手术的超前镇痛，能提高镇痛质量，减轻镇痛的不良反应发生。
Objective:To investigate the preemptive analgesia effects and side effects of the lornoxicam in gynecological operations.Methods:Fifty patients (ASA I-II) were randomly assigned into two groups with 25 cases each. All patients were used epidural analgesia after operations. The group I (the group which used lornoxicam) received intravenous injection of lornoxicam 0.2mg∙kg−1in5 min before surgery, and the concentration of drug used in epidural analgesia is reduced to the half of normal dosage; those patients in group II (the compared group) received intravenous injection of saline 0.2mg∙kg−1and were administered the same epidural analgesia as group I. The visual analog scales (VAS), score of sedation and side effects were recorded at 1, 2, 4, 8, 12, 24 h after surgery. HR, SBP, DBP, MAP, RR, SPO2were recorded at each appointed time. The overall satisfaction to analgesic therapy was evaluated.Results:VAS in the group I at 1, 4, 12, 24 h was lower than that in group II (P< 0.05). There were significant differences between group I and group II in adverse effects. The group I excelled the group II evidently in overall satisfaction to analgesic therapy (P< 0.05).Conclusion:Lornoxicam can produce preemptive analgesia effect in gynecological operation. It can improve the quality of postoperative analgesia and reduce the side effects.
参考文献
| [1] |
龚志毅, 叶铁虎, 于广祥等. 氯诺昔康用于妇科开腹手术后病人自控镇痛的临床研究[J]. 中华麻醉学杂志, 2001, 21: 531-533. |
| [2] |
G. W. Crile. The kinetic theory of shock and its prevention through anoci-association (shockless operation). Lancet, 1913, 182(4688): 7-13. |
| [3] |
H. Vanegas, V. Tortorici. Opioidergic effects of nonopioid analgesics on the central nervous system. Cellular and Molecular Neurobiology, 2002, 22(5-6): 655-661. |
| [4] |
J. Berg, T. Chrisloph and H. Fellier. Theanalqesic NSAID Lomoxicanr inbibirs cox-1/cox-2 iNOs and the formation of IL-6 in vitro. Nanrtngy-Schmiod Arch Phartnacol, 1998, 358(2): R716. |
| [5] |
W. Code. Canadian Journal of Anaesthesia, 1993, 40: 401-405. |
| [6] |
E. R. Detlef, A. Morten, S. Dietmar, et al. A comparison of patient-controlled analgesia withlornoxicam versus morphine in patients undergoing lumbar disk surgeyr. Anesthesia & Analgesia, 1998, 86(5): 1045-1050. |