右美托咪定复合喷他佐辛对全髋关节置换老年患者术后炎性反应及高凝状态的影响

Effects of Dexmedetomidine combined with Pentazocine on postoperative inflammatory response and hypercoagulability in elderly patients underwent total hip replacement

目的研究右美托咪定复合喷他佐辛对全髋关节置换老年患者术后炎性反应及高凝状态的影响。方法选取2016年5月～2017年5月于河北省秦皇岛市第二医院择期行全髋关节置换术治疗的老年患者300例为研究对象,将其以随机数字表法分为研究组与对照组,每组150例。对照组予以喷他佐辛进行镇痛治疗,研究组则予以右美托咪定复合喷他佐辛镇痛治疗。分别比较两组术后炎性反应与高凝状态情况、术后不同时间段疼痛情况以及不良反应发生情况。结果两组患者术前、术后即刻血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平比较,差异无统计学意义(P>0.05),而术后即刻、术后24 h时两组IL-6、TNF-α水平均明显高于术前,但研究组术后24 h低于对照组,差异有统计学意义(P<0.05)。两组患者术前、术后即刻D-二聚体、纤维蛋白原(Fib)水平比较,差异无统计学意义(P>0.05),而术后即刻、术后24 h时两组D-二聚体、Fib水平均明显高于术前,但研究组术后24 h低于对照组,差异有统计学意义(P<0.05)。术后6、12、24 h研究组视觉模拟评分(VAS)均明显低于对照组(P<0.05)。研究组胃肠道反应和眩晕的发生率明显低于对照组(P<0.05),而两组高血压发生率比较差异无统计学意义(P>0.05)。结论右美托咪定复合喷他佐辛应用于全髋关节置换老年患者中可有效改善患者炎性反应以及高凝状态,且有效减轻疼痛,安全性较好。

Objective To study the effect of Dexmedetomidine combined with Pentazocine on postoperative inflammatory response and hypercoagulability in elderly patients underwent total hip replacement. Methods From May 2016 to May 2017, 300 elderly patients who underwent total hip replacement in the Second Hospital of Qinhuangdao were selected as the study subjects. The patients were divided into study group and control group by random number table method, with 150 cases in each group. The control group was treated with Pentazocine for analgesic treatment, and the study group was treated with Dexmedetomidine combined with Pentazocine for analgesic treatment. The postoperative inflammatory response, hypercoagulability, postoperative pain at different time and adverse reactions were compared between the two groups. Results There were no significant differences in serum levels of interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) between the two groups at immediate preoperative and immediate postoperative(P > 0.05),the levels of IL-6 and TNF-α in the two groups at immediate postoperative and postoperative 24 hours were significantly higher than those at immediate preoperative, but the levels of IL-6 and TNF-α in the study group were lower than those in the control group at postoperative 24 hours, the differences were statistically significant(P < 0.05). There were no significant differences in the levels of D-dimer and fibrinogen(Fib) between the two groups at immediate preoperative and immediate postoperative(P > 0.05), the levels of D-dimer and Fib in the two groups at immediate postoperative and postoperative 24 hours were significantly higher than those at immediate preoperative, but the levels of D-dimer and Fib in the study group were lower than those in the control group at postoperative 24 hours, the differences were statistically significant(P < 0.05). Visual analogue scale(VAS) scores in the study group were significantly lower than those in the control group at postoperative6, 12, 24 hours(P < 0.05). The incidence of gastrointestinal reactions and vertigo in the study group were significantly lower than those in the control group(P < 0.05), and there was no significant difference in the incidence of hypertension between the two groups(P > 0.05). Conclusion Dexmedetomidine combined with Pentazocine can effectively improve the inflammatory response and hypercoagulability in elderly patients underwent total hip replacement, and effectively alleviate the pain, and also has a good safety.