氟比洛芬酯预先给药对胸腔镜下肺叶切除患者 术后镇痛和胃肠激素的影响

Effects of preadministration of flurbiprofen on postoperative analgesia and gastrointestinal hormones after video-assisted thoracoscopic lobectomy

摘要:

目的 探讨氟比洛芬酯预先给药对胸腔镜下肺叶切除患者术后镇痛和胃肠激素的影响。 方法 选取2018 年1 月—2018 年12 月连云港市第二人民医院肺癌手术患者60 例作为研究对象，随机分为 观察组和对照组，每组30 例。观察组麻醉诱导前15 min 预先静脉给予氟比洛芬酯50 mg，对照组相同时间 予以等容量脂肪乳5 ml。术毕两组即刻行患者自控静脉镇痛（PCIA），采用芬太尼1.0 mg+ 生理盐水稀释至 100 ml，持续镇痛至术后48 h。记录两组出手术室时（T2）、术后6 h（T3）、术后12 h（T4）及术后24 h（T5） 的疼痛和镇静评分。比较两组入手术室（T0）、术毕时（T1）、术后12 h（T4）血清炎症因子肿瘤坏死因子- α（TNF-α）、白细胞介素-6（IL-6），以及胃泌素（GAS）、胃动素（MTL）表达水平的变化。结果 静息 和运动状态VAS 评分在不同时间、组间及变化趋势上有差异（P <0.05）。镇静评分在不同时间、组间及变化 趋势上无差异（P >0.05）。TNF-α、IL-6、GAS、MTL 在不同时间、组间及变化趋势上有差异（P <0.05）。 观察组恶心呕吐发生率较对照组减少（P <0.05）；两组头晕、嗜睡、面部潮红发生率比较，差异无统计学意 义（P >0.05）。结论 麻醉诱导前预先予以氟比洛芬酯可提高胸腔镜下肺叶切除患者术后镇痛效果，对患者 机体炎症反应及胃肠功能改善具有一定价值，同时能降低患者术后恶心呕吐发生率。

Abstract:

Objective To investigate the effects of preadministration of flurbiprofen on postoperative analgesia and gastrointestinal hormones after video-assisted thoracoscopic lobectomy. Methods Sixty patients with lung cancer treated in our hospital from January 2018 to December 2018 were enrolled in the study, aged 55 to 68 years, with BMI 18 to 25 kg/m2, falling into ASA physical status Ⅰ, Ⅱ. The patients were randomly divided into two groups with 30 cases in each group. Patients in the observation group were given 50 mg flurbiprofen ester intravenously 15 min before anesthesia induction, while the control group was given 5 ml isometric fat emulsion at the same time.Patients in both groups underwent patient-controlled intravenous analgesia (PCIA) immediately after the operation. Fentanyl 1.0 mg + saline was diluted to 100ml and the analgesia continued until 48h after the operation. The pain scores and sedation scores of the two groups were recorded at out of the operating room (T2), 6 h (T3), 24 h (T4) and 48 h (T5) after the operation .The expression levels of TNF-α, IL-6 and Gastrin, Motilin were analyzed and compared at into the operating room (T0), at the end of operation (T1), and 24 h after surgery (T4). Results The VAS scores of resting state and exercise state in the observation group and the control group among different time, group and trend were different (P < 0.05). There was no difference in sedation score between the observation group and the control group among different time, group and trend (P > 0.05). TNF-α, IL-6, GAS and MTL in the observation group and the control group among different time, group and trend were different (P < 0.05). The incidence of nausea and vomiting in the observation group was lower than that in the control group (P < 0.05). There was no significant difference in the incidence of dizziness, drowsiness and facial flushing between the two groups (P > 0.05). Conclusion Preoperative administration of flurbiprofen axetil before induction of anesthesia can improve the postoperative analgesia effect of patients undergoing thoracoscopic lobectomy, improve the inflammatory response and gastrointestinal function, and reduce the incidence of postoperative nausea and vomiting.