老年髋关节置换术患者盐酸氢吗啡酮术后镇痛对应激反应及血液流变学的影响

Effect of hydromorphone hydrochloride postoperative analgesia on the stress reaction and hemorheology in elderly patients after total hip replacement

目的:探讨盐酸氢吗啡酮术后镇痛对老年髋关节置换术(THR)患者应激反应和血液流变学的影响。方法:选取于我院实施THR患者70例为研究对象,随机分为观察组和对照组各35例,两组均于手术结束后立即连接自控镇痛泵,观察组以盐酸氢吗啡酮,对照组以舒芬太尼进行自控镇痛。两组于术前、术后12、24h采集外周静脉血,采用放射免疫法测定血糖(BG)、皮质醇(Cor),酶联免疫法测定去甲肾上腺素(NE);于术前、术后24h、术后72h采集外周静脉血,采用全自动血液分析仪测定血浆黏度(PV)、全血黏度(BV)和全血还原黏度(RWBV)。结果:术后12、24h观察组Cor、NE水平和对照组BG、Cor、NE水平均高于术前,但对照组各时间点明显高于观察组;术后24、72h两组PV、BV(低切、中切、高切)、RWBV(低切、中切、高切)水平均高于术前,但对照组各时间点明显高于观察组。结论:盐酸氢吗啡酮用于老年THR患者术后镇痛具有良好的镇痛效果,可有效减轻术后应激反应,稳定血液流变学,有利于机体的康复。

Objective：To explore the effect of hydromorphone hydrochloride postoperative analgesia on the stress reac-tion and hemorheology in elderly patients after total hip replacement （THR）.Methods：A total of 70 patients who were admit-ted in our hospital from June,201 5 to June,201 6 for THR were included in the study and randomized into the observation group and the control group with 35 cases in each group.After operation,the patients in the two groups were immediately giv-en patient-controlled analgesia.The patients in the observation group were given hydromorphone hydrochloride,while the pa-tients in the control group were given sufentanil.The peripheral venous blood before operation,12 h and 24 h after operation in the two groups was collected.RIA was used to detect BG and Cor.ELISA was used to detect NE.The peripheral venous blood before operation,24 h and 72 h after operation was collected.The full automatic hematology analyzer was used to detect the plasma PV,BV,and RWBV.Results：Cor and NE levels in the observation group,and BG,Cor,and NE levels in the control group 12h and 24h after operation were significantly elevated when compared with before operation （P 〈0.05）,but the above＆nbsp;indicators at each timing point in the control group were significantly higher than those in the observation group （P 〈0.05 ）. PV,BV （low-shear,middle-shear,and high-shear）,and RWBV （low-shear,middle-shear,and high-shear）levels 24h and 72h after operation in the two groups were significantly elevated when compared with before operation （P 〈0.05）,but the a-bove indicators at each timing point in the control group were significantly higher than those in the observation group （P 〈0.05）.Conclusions：Application of hydromorphone hydrochloride in the postoperative analgesia in elderly patients with THR has a preferable analgesia effect,can effectively alleviate the postoperative stress reaction,stabilize the hemorheology,and contrib-ute to the rehabilitation.