中国癌症杂志
中國癌癥雜誌
중국암증잡지
CHINA ONCOLOGY
2010年
2期
151-155
,共5页
王敬%朱敏敏%朱谮%曹云开
王敬%硃敏敏%硃譖%曹雲開
왕경%주민민%주참%조운개
超前镇痛%氟比洛芬酯%颈丛神经阻滞%多模式%不良反应
超前鎮痛%氟比洛芬酯%頸叢神經阻滯%多模式%不良反應
초전진통%불비락분지%경총신경조체%다모식%불량반응
preemptive analgesia%flurbiprofen axetil injection%cervical plexus nerve block%multimodal%side effect
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C 3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30 min及皮肤缝合毕即刻分别给氟比洛芬酯50 mg稀释至20 mL静脉缓慢(1 min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、24 h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4 h和8 h(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24 h(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、完善、长效的镇痛效果,起到阿片类药物节约效应,可有效地减少其不良反应的发生.
揹景與目的:超前鎮痛是傷害性刺激作用于機體之前採取的一種措施,可防止神經中樞敏感化,減少和消除傷害引起的疼痛.本研究採用氟比洛芬酯聯閤頸叢神經阻滯用于甲狀腺癌聯閤根治術的超前鎮痛,採用多藥物多途徑的多模式聯閤超前鎮痛,以儘可能消除外週和中樞敏化的形成,從而取得完善、長效的鎮痛效果.方法:2009年6-8月間,選擇60例擇期行單側甲狀腺癌聯閤根治術的患者,隨機分成A、B和C 3組,A組:氟比洛芬酯+頸叢神經阻滯作為的聯閤超前鎮痛;B組:頸叢神經阻滯作為超前鎮痛;C組:單純全痳組.A組術前30 min及皮膚縫閤畢即刻分彆給氟比洛芬酯50 mg稀釋至20 mL靜脈緩慢(1 min以上)推註,B、C組分彆在相同時點給予生理鹽水對照,A、B組均行雙側淺頸叢神經阻滯,給予0.375%囉派卡因20mL.記錄A、B兩組頸叢阻滯起效時間、手術時間、拔管時間以及芬太尼用量.分彆于術後1、4、8、24 h疼痛視覺模擬評分(visual analogue scale,VAS)(靜息和活動),以及噁心嘔吐、嗜睡、呼吸抑製等不良反應的髮生情況.結果:在神經阻滯的起效時間上A、B組分彆是(7.47±1.04)和(8.75±1.36)min,兩組相比差異有統計學意義(P<0.05);術中A、B和C組芬太尼用量分彆是(0.36±0.04)、 (0.40±0.06)和(0.45±0.07)mg,A組與B組、A組與C組相比,差異均有統計學意義(P<0.05,P<0.01);術後疼痛視覺模擬評分方麵,術後4 h和8 h(活動)A、B組與C組分彆是(26±8)和(32±6)、(25±6)和(37±5)、(36±6)和(40±6)mm,A組與C組、B組與C組、A組與B組相比,差異均有統計學意義(P均<0.05);而術後24 h(靜息和活動)A、B和C組分彆是(25±4)和(34±5)、(27±5)和(36±5)、(31±5)和(40±6)mm,A組與C組相比,差異有統計學意義(P<0.05).不良反應方麵,噁心嘔吐髮生情況A、B與C組分彆是1、0和5例.結論:氟比洛芬酯聯閤頸叢神經阻滯用于甲狀腺癌聯閤根治術的超前鎮痛可以提供更加快速、完善、長效的鎮痛效果,起到阿片類藥物節約效應,可有效地減少其不良反應的髮生.
배경여목적:초전진통시상해성자격작용우궤체지전채취적일충조시,가방지신경중추민감화,감소화소제상해인기적동통.본연구채용불비락분지연합경총신경조체용우갑상선암연합근치술적초전진통,채용다약물다도경적다모식연합초전진통,이진가능소제외주화중추민화적형성,종이취득완선、장효적진통효과.방법:2009년6-8월간,선택60례택기행단측갑상선암연합근치술적환자,수궤분성A、B화C 3조,A조:불비락분지+경총신경조체작위적연합초전진통;B조:경총신경조체작위초전진통;C조:단순전마조.A조술전30 min급피부봉합필즉각분별급불비락분지50 mg희석지20 mL정맥완만(1 min이상)추주,B、C조분별재상동시점급여생리염수대조,A、B조균행쌍측천경총신경조체,급여0.375%라파잡인20mL.기록A、B량조경총조체기효시간、수술시간、발관시간이급분태니용량.분별우술후1、4、8、24 h동통시각모의평분(visual analogue scale,VAS)(정식화활동),이급악심구토、기수、호흡억제등불량반응적발생정황.결과:재신경조체적기효시간상A、B조분별시(7.47±1.04)화(8.75±1.36)min,량조상비차이유통계학의의(P<0.05);술중A、B화C조분태니용량분별시(0.36±0.04)、 (0.40±0.06)화(0.45±0.07)mg,A조여B조、A조여C조상비,차이균유통계학의의(P<0.05,P<0.01);술후동통시각모의평분방면,술후4 h화8 h(활동)A、B조여C조분별시(26±8)화(32±6)、(25±6)화(37±5)、(36±6)화(40±6)mm,A조여C조、B조여C조、A조여B조상비,차이균유통계학의의(P균<0.05);이술후24 h(정식화활동)A、B화C조분별시(25±4)화(34±5)、(27±5)화(36±5)、(31±5)화(40±6)mm,A조여C조상비,차이유통계학의의(P<0.05).불량반응방면,악심구토발생정황A、B여C조분별시1、0화5례.결론:불비락분지연합경총신경조체용우갑상선암연합근치술적초전진통가이제공경가쾌속、완선、장효적진통효과,기도아편류약물절약효응,가유효지감소기불량반응적발생.
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 n 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.
