右美托咪定复合地佐辛对关节置换术患者镇痛效果及对儿茶酚胺、内皮素-1的影响

The dexmedetomidine combined with dezocine on the analgesic effect of joint replacement patients and the influence of catecholamine and endothelin-1

目的分析右美托咪定联合地佐辛用于关节置换术患者镇痛效果及对血浆儿茶酚胺及内皮素-1的影响。方法选取本院78例择期行髋关节置换手术的患者,随机分为观察A组、对照B组,各39例。术后镇痛时A组给予右美托咪定和地佐辛,B组注射地佐辛和帕瑞昔布。于麻醉诱导前5min(T0)和术后8h(T1)、16h(T2)、24h(T3)四个时间点检测记录患者的收缩压(SBP)、舒张压(DBP)、心率(HR)、儿茶酚胺[肾上腺素(Adr)、去甲肾上腺素(NE)]、内皮素-1(ET-1)的水平,比较组间差异。结果两组患者手术时间无明显差异,但A组患者苏醒时间明显短于B组,VAS评分明显低于B组,差异有统计学意义(P<0.05)。另外,患者的SBP、DBP、HR、Adr、NE、ET-1均先逐渐上升,然后逐渐下降,24h时基本恢复到术前水平。T1、T2时组间比较,A组各指标均明显低于B组,差异有统计学意义(P<0.05)。结论右美托咪定联合地佐辛用于髋关节置换术后镇痛,效果好,且对儿茶酚胺和内皮素-1的影响较小,血压和心率更加平稳,值得推广应用。

Objective To analyze the influences of dexmedetomidine combined with dezocine on the analgesic effect of joint replacement patients and the influence of plasma catecholamine and endothelin-1. Methods 78 patients with hip arthroplasty in my hospital were randomly divided into observation group A and control group B, 39 cases in each group. During postoperative analgesia, the group A received dexmedetomidine combined with dezocine,while the group B received the injection of dezocine and parecoxib.The systolic blood pressure（SBP）, diastolic blood pressure（DBP）,heart rate（HR）, catecholamines of adrenalin（Adr） and noradrenaline（NE）, and endothelin-1（ET-1） levels were detected and recorded on four time points of 5 min before anesthesia induction（T0）,postoperative 8h（T1）,16h（T2） and 24h（T3）,the differences of the two groups were compared. Results There was no significant difference in operation time of the two groups,but in the group A,the recovery time was obviously shorter than that of the group B, the VAS score was significantly lower than that of the group B,the difference of the two groups was significant（P〈0.05）.In addition,the SBP,DBP,HR,Adr,NE,and ET-1 in patients both first gradually increased, then gradually decreased,which basically recovered to preoperative levels at 24 h. The T1 and T2 of the two groups were compared,the indexes of the group A were both obviously lower than that of the group B, the difference had statistical significance（P〈0.05）. Conclusion Dexmedetomidine combined with dezocine on the postoperative analgesia of hip replacement had good effect, less affected on catecholamine and ET-1,and more stabilized blood pressure and heart rate, which was worthy of promotion and application.