氧化亚氮吸入镇痛对老年骨科患者术后恢复的影响

Effects of nitrous oxide inhalation analgesia on the postoperative recovery in elderly patients undergoing orthopedics surgery

目的观察氧化亚氮吸入镇痛对老年骨科患者术后恢复的影响。方法选取2018年9月至2019年9月接受骨科手术治疗的老年患者76例,随机分为对照组和试验组,每组38例。对照组给予局部注射1%利多卡因,试验组给予氧化亚氮吸入联合局部麻醉。比较2组镇痛效果、补救镇痛率、疼痛介质[5-羟色胺(5-HT)、前列腺素E2(PGE2)]、应激激素[白介素6(IL-6)、C-反应蛋白(CRP)、皮质醇(Cor)]、脑氧代谢指标[颈内静脉血氧饱和度(SjvO2)、脑动静脉血氧含量差(AVDO2)、脑氧摄取率(CERO2)]、S100钙结合蛋白(S100β)、神经元特异性烯醇酶(NSE)、简易精神状态检查量表(MMSE)评分及认知功能障碍(POCD)发生率。结果试验组术后6 h、24 h、48 h VAS评分、补救镇痛率、POCD发生率显著低于对照组,差异有统计学意义(P<0.05)。2组术前5-HT、PGE2、IL-6、CRP、Cor、SjvO2、AVDO2、CERO2、S100β、NSE、MMSE评分比较差异无统计学意义(P>0.05);2组术后5-HT、PGE2、IL-6、CRP、Cor、SjvO2、S100β、NSE均显著高于术前,AVDO2、CERO2、MMSE评分均显著低于术前,差异有统计学意义(P<0.05),且试验组5-HT、PGE2、IL-6、CRP、Cor、AVDO2、CERO2、S100β、NSE低于对照组,SjvO2、MMSE评分高于对照组(P<0.05)。结论老年骨科患者术中应用氧化亚氮吸入镇痛效果良好,能够有效减轻术后疼痛和应激反应,改善脑氧代谢和认知功能。

Objective To investigate the effects of nitrous oxide inhalation analgesia on the postoperative recovery in elderly patients after orthopedics surgery.Methods A total of 76 elderly patients who were treated by orthopedic surgery in our hospital from September 2018 to September 2019 were randomly divided into control group(n=38)and experimental group(n=38).The patients in control group were given intravenous injection of 1%lidocaine,however,the patients in experimental group were given nitrous oxide inhalation combined with local anesthesia.The analgesia effects,remedial analgesia rate,pain-related neurotransmitter(5-HT and PGE2),stress response molecules(IL-6,CRP and Cor),cerebral oxygen metabolism indexes(SjvO2,AVDO2 and CERO2),S100β,NSE,MMSE scores and incidence of POCD were observed and compared between the two grousp.Results The VAS scores at 6h,24h,48h after operation,remedial analgesia rates and the incidence rate of POCD in experimental group were significantly lower than those in control group(P<0.05).Before operation there were no significant differences in the levels of 5-HT,PGE2,IL-6,CRP,Cor,SjvO2,AVDO2,CERO2,S100β,NSE and MMSE scores between two groups(P>0.05).After operation,the levels of 5-HT,PGE2,IL-6,CRP,Cor,SjvO2,S100βand NSE were significantly increased in both groups,as compared with those before operation,however,the levels of AVDO2,CERO2 and MMSE scores were significantly decreased(P<0.05).Moreover the levels of 5-HT,PGE2,IL-6,CRP,Cor,AVDO2,CERO2,S100βand NSE in experimental group were significantly lower than those in control group,however,the levels of SjvO2 and MMSE scores in experimental group were significantly higher than those in control group(P<0.05).Conclusion The nitrous oxide inhalation analgesia can obviously relieve postoperative pain and stress responsem,improve cerebral oxygen metabolism and cognitive function of elderly patients undergoing orthopedic surgery.