地佐辛天枢穴注射在无痛肠镜中的应用及作用机制的研究

Therapeutic effection and mechanism of dizocine a cupoint injection in painless colonoscopy

[目的]观察预先地佐辛天枢穴肌肉注射联合丙泊酚在无痛肠镜中应用的临床疗效及对5-羟色胺(5-HT)、β-内啡肽(β-EP)、脑源性神经因子(BDNF)因子表达的影响。[方法]按随机数字表法将无痛肠镜患者分为观察组[地佐辛(天枢穴注射,无痛肠镜前15min)+丙泊酚]、对照组1[地佐辛(臀部肌注,无痛肠镜前15min)+丙泊酚]、对照组2(丙泊酚)。以平均动脉压(MAP)、呼吸(R)、心率(HR)、血样饱和度(SPO2)、RSS躁动评分、VAS疼痛评分、5-HT、BDNF、β-EP水平作为评价疗效的指标。[结果](1)对照组2中MAP、R、HR、SPO2均低于其余2组,丙泊酚用量高于其他2组(P<0.05),且观察组中丙泊酚用量低于对照组1(P<0.05)。(2)观察组、对照组1在无痛肠镜通过脾曲时、退镜结束后RSS躁动评分、VAS疼痛评分均低于对照组2,且治疗组更低(P<0.05)。(3)观察组、对照组1中5-HT、BDNF、β-EP水平高于对照组2,观察组最高(P<0.05)。[结论]无痛肠镜前地佐辛肌注联合丙泊酚效果确切,天枢穴注射效果更好,可能通过上调5-HT、β-EP、BDNF表达水平达到镇静镇痛作用。

[Objective]Clinical observation of dezocine Tianshu intramuscular injection combined with propofol in painless colonoscopy and the expression of 5-of serotonin（5-HT）,β-endorphin（beta-EP）,brainderived neurotrophic factor（BDNF）.[Methods]Painless colonoscopy were divided into observation group（intramuscular injection of dezocine at Tianshu,painless colonoscopy before 15 min）,control group 1[propofol＋ dezocine（Intramuscular injection of the buttocks,painless colonoscopy before 15 min）]and control group 2（propofol）randomly.Mean arterial pressure（MAP）,respiratory rate（R）,heart rate（HR）,blood sample saturation（SPO2）,RSS restlessness score,VAS pain score,5-HT,BDNF andβ-EP level were used as indicators for evaluating curative effect.[Results]1 MAP,R,HR and SPO2 in the control group 2 were lower than those in the other two groups.The dosage of propofol in the control group 2 was higher than that in the other two groups（P0.05）,and the dosage of propofol in the observation group was lower than that in the control group 1（P0.05）.2 Both in the observation group and the control group1,the RSS agitation score and the VAS pain score were lower than those in the control group 2,and the observation group was lower than the control group after the painless enteroscopy and passed through the splenic flexure（P0.05）.3 The levels of 5-HT,BDNF andβ-EP in the observation group and the control group1 were higher than those in the control 2,and the observation group was the highest（P0.05）.[Conclusion]Painless colonoscopy before intramuscular injection of dezocine combined with propofol is effective,and theeffect is better than the injection of Tianshu intragluteal injection,the possible mechanism to reach the level of sedation and analgesia is the up-regulation of the expression of 5-HT,β-EP and BDNF