右美托咪定复合舒芬太尼镇痛对老年髋关节置换术后患者镇痛效果、应激反应及炎症因子的影响

Effects of dexmedetomidine combined with sufentanil on analgesic effect,stress response and inflammatory factors in elderly patients undergoing hip arthroplasty

目的探讨右美托咪定复合舒芬太尼对老年髋关节置换术后镇痛效果、应激反应及炎症因子的影响。方法选取2014年6月至2016年6月行单侧髋关节置换治疗的老年患者,随机分为两组,每组各45例。对照组术后给予舒芬太尼镇痛,观察组给予右美托咪定复合舒芬太尼镇痛。比较两组患者术后6h(T1)、术后12h(T2)、术后24h(T3)、术后48h(T4)镇痛效果、应激激素和炎症因子的差异。结果观察组48h内PCIA按压次数(14.6±6.2)次,对照组按压(36.7±9.2)次,两组间差异具有统计学意义(t=13.363,P<0.05)。在T1、T2、T3时间点,观察组VAS评分均低于对照组(P<0.05),而Ramsay评分高于对照组(P<0.05),但两组在T4时间点的差异无统计学意义(P>0.05)。术前,两组患者血浆皮质醇(Cor)、肾上腺素(E)、去甲肾上腺素(NE)、白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)的差别均无统计学意义(P>0.05);术后T1、T2、T3、T4各时间点,两组患者Cor、E、NE、IL-6、TNF-α均较同组术前明显升高(P<0.05),但观察组各指标均低于同时间点的对照组(P<0.05)。结论右美托咪定复合舒芬太尼镇痛应用于老年髋关节置换术后患者,具有镇痛效果显著、减轻应激反应以及降低血清炎症因子作用。

Objective To investigate the effects of dexmedetomidine combined with sufentanil on analgesic effect, stress response and inflammatory factors in elderly patients with hip arthroplasty. Methods 90 elderly patients with unilateral hip arthroplasty from June 2014 to June 2016 were elected and randomly divided into two groups（n=45）. The control group was given sufentanil analgesia after surgery, while the observation group given dexmedetomidine combined with sufentanil analgesic. The analgesic effect, stress hormone and inflammatory factors were compared between the two groups 6 h（T1）, 12 h（T2） ,24 h（T3） and 48 h（T4） after operation. Results The number of PCIA compression in the observation group was （14.6 ± 6.2）, which was significantly different from the control group （36.7 ±9.2; t=3. 363,P〈0.05）. At the timepoint of T1,T2 and T3, the VAS score of the observation group was lower than that of the control group （P〈0. 05） ,and higher in Ramsay score （P〈0.05）,but there was no significant difference between the two groups at T4 （P〉0 05）. Before surgery （T0）, there was no significant difference in plasma cortisol （Cot）, adrenaline （E）, norepinephrine （NE）, interleukin-6 （IL-6） and tumor necrosis factor-α （TNF-α） between the two groups （P〈0.05）. At the timepoint of T1,T2,T3 and T4, the levels of Cot, E, NE, IL-6 and TNF-α in the two groups were all significantly increased than those in TO （P〈0.05）, but the observation group were lower than the control group at the same timepoint （P〈0.05）. Conclusion Dexmedetomidine combined with sufentanil analgesia has excellent analgesic effect in elderly patients with hip arthroplasty. It can reduce stress response and serum inflammatory factors.