纳布啡超前镇痛对全髋关节置换术老年患者炎性因子和早期认知功能的影响

Effects of preemptive analgesia with nalbuphine on inflammatory factors and early cognitive function in elderly patients undergoing hip replacement

目的观察纳布啡超前镇痛对全髋关节置换术老年患者炎性因子和早期认知功能的影响。方法择期全身麻醉下全髋关节置换术老年患者84例,随机数字表法均分为纳布啡组(N组)和对照组(C组),全身麻醉诱导前,N组静脉注射纳布啡0.2 mg/kg,C组给予等量生理盐水,术后接同一配方静脉镇痛泵(PCA)。两组分别于术前1 d(T0)、术后2 h(T1)、术后12 h(T2)、术后24 h(T3)采集静脉血,检测血清白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)浓度,观察和记录患者拔管后Ramsay评分和T1~T3时的VAS评分,记录术后PCA追加按压总次数;于术前1 d及术后1 d、3 d、5 d,采用简易智能量表(MMSE)对患者进行神经精神功能测试评分。结果与T0时比较,两组血清IL-6和TNF-α浓度在T1~T3时均升高(P<0.05),但N组低于C组(P<0.05);N组在T1~T2时的VAS评分低于C组(P<0.05),术后PCA追加按压总次数少于C组(P<0.05);两组拔管后Ramsay评分差异无统计学意义(P>0.05);与术前1 d比较,仅C组MMSE评分在术后1 d、3 d均降低,且低于N组(P<0.05),在术后5 d内,N组术后认知功能障碍(POCD)发生率低于C组(7.1%vs.23.8%,P<0.05)。结论纳布啡超前镇痛可降低全髋关节置换术老年患者术后早期急性疼痛和炎性反应,并能降低早期POCD的发生率。

Objective To investigate the effects of preemptive analgesia with nalbuphine on inflammatory fac- tors and early cognitive function in elderly patients undergoing hip replacement. Methods Eighty-four elderly patients undergoing selective hip replacement under general anesthesia were randomly divided into nalbuphine group （N） and control group （C） with 42 in each group. Group N received nalbuphine intravenously at a dose of 0. 2 mg/kg before anesthetic induction. Group C received the same volume of normal saline. The same intravenous analgesia pump is a- dopted after operation. Plasma levels of IL-6 and TNF-a were measured at different time points ： 1 d before operation （ T0 ） , and 2 h （ T1 ） , 12 h （ T2 ） and 24 h （ T3 ） after operation. The VAS, Ramsay score and total number of additional times of intravenous PCA were observed and recorded. Mini-Mental State Examination （MMSE） was used to assess the cognitive function 1 d before operation and 1 d,3 d and 5 d after operation. Results Compared with T0 ,the plasma levels of IL-6 and TNF-a at T1 - T3 in the two groups were increased （P 〈 0. 05 ） , and the levels in group N were low- er than those of group C （P 〈 0. 05 ）. The total number of additional times of intravenous PCA in group N was fewer than that of group C （ P 〈 0. 05 ） , and the VAS at TI and T2 was lower （ P 〈 0. 05 ）. There was no significant difference in Ramsay scores between the two groups after extubation （P 〉 0. 05 ）. MMSE scales in group C at 1 d and 3 d after operation were lower than those at 1 d before operation and group N （P 〈 0. 05 ）. The incidence rate of POCD in group N was lower than that of group C within 5 d after operation （7. 1% vs. 23. 8% ,P 〈 0. 05 ）. Conclusion Preemptive analgesia with nalbuphine can reduce the early acute pain and inflammatory response in elderly patients who undergo hip replacement,and decrease the incidence rate of early POCD.