伊痛舒穴位注射对机械通气患者血浆5-羟色胺及β-内啡肽的影响

The effects of the plasma levels of serotonin and neuropeptide on ventilated patients with Yitongshu （伊痛舒） acupuncture points injection

目的观察镇痛药物伊痛舒穴位注射对机械通气患者血浆5-羟色胺（5-HT）、β-内啡肽（pEP）含量变化的影响。方法28例机械通气患者按照随机数字表法分为眯唑安定＋芬太尼组（对照组）和咪唑安定＋芬太尼＋伊痛舒组（伊痛舒组）两组，每组14例。两组相应镇静药物以注射泵持续静脉内泵入，并根据疼痛和镇静效果调节剂量，使患者视觉模拟评分（VAS）≤3N4分、Ramsay镇静评分2～4分。伊痛舒组于镇静后11h及23h经患者双侧足三里穴注射伊痛舒注射液，每次4ml。记录患者镇静前及镇静1、12、24h的平均动脉压（MAP）、心率（HR）、呼吸频率（RR）、脉搏血氧饱和度（SpO2）、氧合指数（PaO2／FiO2）、气道峰压（Paw）及VAS、Ramsay镇静评分；分别于镇静前及镇静12h、24h取静脉血3ml，测定血浆5-HT及β-EP。结果与本组镇静前比较，两组患者镇静后各时间点HR、VAS评分均显著下降，Ramsay镇静评分显著升高，MAP在1h、RR在12h和24h及Paw在24h均降低，PaO2／FiO2在24h显著升高。伊痛舒组12h和24h血浆中5-HT含量[（101．45±14．67）ng／L，（104．86±11．74）ng／L3均明显高于对照组[（61．57±10．62）ng／L，（59．86土8．64）ng／L，均P〈0．053，而两组间pEP含量比较差异无统计学意义（对照组：12h为（162．72±38．44）ng／L，24h为（151．83±24．54）ng／L；伊痛舒组：12h为（169．35±28．10）ng／L，24h为（159．41±15．89）ng／L，均P〉0．053。结论伊痛舒注射液能降低机械通气患者血浆5-HT含量，对β-EP无明显影响。

Objective To evaluate the change in the plasma levels of serotonin β-hydroxytryptamine） and neuropeptide （β-endorphin,β-EP） after injection of Yitongshu （伊痛舒） into Zusanli points （足三里穴） in patients under mechanical ventilation. Methods Twenty-eight patients undergoing mechanical ventilation were randomly divided into two groups： midazolam combined with fentanyl group （control group, n= 14） and midazolam combined with fentanyl and Yitongshu group （Yitongshu group, n= 14）. The drugs were given to the patients continuously intravenously with an injection pump in an even rate, with the dosage adjusted to reach the sedative target of visual analog score （VAS）≤3 - 4 and Ramsay 2 - 4. Yitongshu injection （4 ml） was injected into the Zusanli point on both sides 11 hours or 23 hours after administration of the durgs in Yitongshu group. The hemodynamic and respiratory parameters, including mean arterial pressure （MAP）, heart rate （HR）, respiratory rate （RR）, pulse oxygen saturation （SpO2）, oxygenation index （PaO2/FiO2） and pressure airway （Paw）, were recorded, and the sedation levels （VAS and Ramsay） were evaluated before sedation and 1, 12, 24 hours after sedation in these patients. The plasma levels of 5-hydroxytryptamine and β-EP were examined before sedation, 12 hours and 24 hours after sedation. Results Compared with that before sedation, HR and VAS score were significantly lower, and Ramsay score was significantly higher in both groups. MAP was significantly lower at 1 hour, and RR at 12 hours and 24 hours, as well as the Paw at 24 hours, and the PaO2/FiO2 was significantly higher at 24 hours. The level of 5-hydroxytryptamine at 12 hours and 24 hours in Yitongshu group [（101.45±14.67） ng/L, （104.86±11.74） ng/L] was significantly higher than that in control group [（61.57±10. 62） ng/L, （59.86± 8. 64） ng/L, both P〈0.05]. But the level of β-EP showed no difference between two groups [control group： （162.72 ± 38.44） ng/L at 12 hours, （151.83 ± 24.54） ng/L at 24 hours; Yitongshu group： （169.35 ±28.10） ng/L at 12 hours, （159.41 ±15.89） ng/L at 24 hours, both P〈0. 05]. Conclusion Yitongshu injection can reduce the plasma level of 5-hydroxytryptamine in ventilated patients, but with no effect on β-EP.