右美托咪定联合枸橼酸芬太尼注射液用于腹腔镜下阑尾切除术后镇痛效果及对炎性因子水平的影响

Analgesic efficacy of dexmedetomidine combined with fentanyl citrate injection in patients undergoing laparoscopic appendectomy and its effects on inflammatory factor level

目的探究右美托咪定联合枸橼酸芬太尼注射液用于腹腔镜下阑尾切除术后的镇痛效果及对炎性因子水平的影响。方法选取2017年4月至2019年3月在杭州市大江东医院接受腹腔镜切除术的阑尾炎患者200例为研究对象,按照随机数字表法分为对照组100例和观察组100例。对照组单独采用枸橼酸芬太尼注射液麻醉,观察组则在对照组的基础上联合使用右美托咪定麻醉,比较两组术后不同时间点的视觉模拟疼痛量表(VAS)评分,手术前后C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)等炎性因子水平及不良反应发生率。结果在VAS评分方面,观察组术后6 h、12 h、24 h、48 h的评分均低于对照组,差异均有统计学意义(t=4.671、9.594、10.877、12.358,均P<0.001)。术前,两组CRP、IL-6和TNF-α水平相比较,差异均无统计学意义(t=0.224、0.188、0.421,均P>0.05);术后24 h,两组CRP、IL-6和TNF-α水平均较术前上升,但观察组低于对照组,差异均有统计学意义(t=2.496、2.209、3.165,均P<0.05)。对照组不良反应发生率为8.00%(8/100),观察组不良反应发生率为10.00%(10/100),两组差异无统计学意义(χ^(2)=0.244,P>0.05)。结论腹腔镜下阑尾切除手术中,采用右美托咪定联合枸橼酸芬太尼注射液进行麻醉,镇痛效果良好,有利于抑制机体的炎性因子表达,降低各炎性因子水平,不良反应少,安全性高。

Objective To investigate the analgesic efficacy of dexmedetomidine combined with fentanyl citrate injection in patients undergoing laparoscopic appendectomy and its effects on inflammatory factor level.Methods 200 patients with appendicitis who underwent laparoscopic appendectomy in Hangzhou Dajiangdong Hospital from April 2017 to March 2019 were included in this study.They were randomly assigned to receive postoperative anesthesia either with fentanyl citrate injection alone(control group,n=100)or fentanyl citrate injection combined with dexmedetomidine(observation group,n=100).At different time points after surgery,Visual Analogue Scale(VAS)score was compared between the two groups.Inflammatory factors C-reactive protein,interleukin-6,and tumor necrosis factor-αlevels before and after surgery,and the incidence of adverse reactions were compared between the two groups.Results At 6,12,24 and 48 hours after surgery,VAS score in the observation group was significantly lower than that in the control group(t=4.671,9.594,10.877 and 12.358,all P<0.001).Before surgery,there were significant differences in C-reactive protein,interleukin-6,and tumor necrosis factor-αlevels between the two groups(t=0.224,0.188,0.421,all P>0.05).At 24 hours after surgery,C-reactive protein,interleukin-6,and tumor necrosis factor-αlevels in each group were significantly increased compared with before surgery,and C-reactive protein,interleukin-6,and tumor necrosis factor-αlevels in the observation group were significantly lower than those in the control group(t=2.496,2.209,3.165,all P<0.05).There was no significant difference in the incidence of adverse reactions between the control and observation groups[8.00%(8/100)vs.10.00%(10/100),χ^(2)=0.244,P>0.05].Conclusion Dexmedetomidine combined with fentanyl citrate injection exhibits good and anesthesic and analgesic effects during laparoscopic appendectomy,helps inhibit the expression of inflammatory factors,reduces the level of inflammatory factors,leads to less adverse reactions,and is highly safe.