氯诺昔康在神经外科术后静脉自控镇痛中的应用

目的:观察经额部、颞部入路的神经外科病人术后的疼痛情况以及氯诺昔康用于此类神经外科病人术后静脉自控镇痛的临床效果.方法:36例择期经额部、颞部入路的神经外科手术病人,随机分为二组:氯诺昔康组(L组)镇痛药物为氯诺昔康每mL0.8 mg;对照组(N组)术后当病人主诉疼痛明显,难以忍受时予口服颅痛定30mg.记录各组病人术前及术后4、16、24、48 h的心率、平均动脉压、呼吸频率、脉搏氧饱和度及瞳孔变化.记录各组病人术后4、16、24及48 h的疼痛模拟评分(VAS)、Ramsay镇静评分及术后的凝血指标和术后发生恶心呕吐的情况.结果:L组病人的心率、平均动脉压术前与术后各时段点比较无显著差异(P＞0.05);N组病人术后4 h的心率、平均动脉压较术前显著增加,差异有统计学意义(P＜0.05).两组病人均未出现明显的呼吸抑制,Ramsay镇静评分均不超过3分,在术后各时段点差异均无统计学意义(P＞0.05).术后4、16 h L组VAS评分均显著低于N组(P＜0.05),术后24、48 h二组VAS评分差异无显著性(P＞0.05).未镇痛组的病人在术后24 h内有10例需要使用颅痛定.两组病人术前术后血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)均在正常值范围内.L组和N组病人均有不同程度的恶心呕吐情况出现,各组的呕吐发生率均为33.33%.结论:经额、颞部入路的神经外科病人手术后存在术后疼痛,且大多发生在术后第1 d.氯诺昔康能为其提供良好的术后镇痛疗效,术后镇痛中无明显的呼吸抑制、镇静及凝血指标异常等不良反应.

Intravenous lornoxicam for patient-controlled analgesia in neurosurgery

Aim:This study is to investigate postoperative pain conditions of neurosurgery patients and observe the effects of analgesic treatment of lornoxicam used in patient-controlled analgesia intravenously. Methods:Thirty-six patients underwent neurosurgery for frontal and temporal occupying diseases were divided into tow groups randomly.HR,RR,SpO2,MAP and pupils' diameters are measured before surgery,4 hours,16 hours,24 hours and 48 hours after surgery.VAS scores and Ramsay scores were recorded at 4 hours,16 hours,24 hours and 48 hours after surgery.Postoperative nausea and vomiting were observed and the vomiting scores were recorded.Coagulation index such as PT,APTT were recorded.Results:There were no significant differences in HR and MAP before and after surgery in group L.In group N,HR and MAP were faster at 4 hours after surgery than before surgery.VAS scores in group L were lower than in Group N at 4 hours and 16 hours after surgery(P<0.05).In group N,ten patients asked for rotundium within 24 hours after operation,but there was no one after 24 hours.The incidence of vomiting in two groups were the same.There was no significant deference.PT and APTT test in two groups were normal.Conclusion:The patients undergone neurosurgery on frontal and temporal occupying diseases fell pain postoperatively,almost existing at the first postoperative day.Lornoxicam can supply enough analgesic treatment for neurosurgery patients,without respiratory depression and sedative effects.