氢吗啡酮复合罗哌卡因在髋关节置换术后自控镇痛中的应用效果及对炎症因子水平的影响

Application effect of Hydromorphone complex Ropivacaine in controlled analgesia after hip replacement and effect on inflammatory factor levels

目的探讨髋关节置换术后自控镇痛给予氢吗啡酮复合罗哌卡因的应用效果及对炎症因子水平的影响。方法选取2019年2月至2020年6月潜江市中心医院收治的110例行髋关节置换术的患者作为研究对象,按照随机数字表法分成观察组与对照组,每组各55例。对照组给予盐酸吗啡复合罗哌卡因自控镇痛,观察组给予氢吗啡酮复合罗哌卡因自控镇痛,比较两组疼痛程度、炎症因子水平及应激反应指标。结果两组术后8、12、24 h的视觉模拟评分法(VAS)评分低于本组术后4 h,差异有统计学意义(P<0.05);术后4、8、12、24 h,观察组的VAS评分低于同期对照组,差异有统计学意义(P<0.05)。术前,两组的白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平比较,差异无统计学意义(P>0.05);术后8 h,观察组的IL-6、TNF-α水平低于同期对照组,差异有统计学意义(P<0.05);术后8 h,观察组的IL-10水平高于同期对照组,差异有统计学意义(P<0.05);术后8 h,两组的IL-6、TNF-α水平高于本组术前,差异有统计学意义(P<0.05);术后8 h,两组的IL-10水平低于本组术前,差异有统计学意义(P<0.05)。术前,两组的皮质醇(Cor)、去甲肾上腺素(NE)水平比较,差异无统计学意义(P>0.05);术后8 h,观察组Cor、NE水平低于同期对照组,差异有统计学意义(P<0.05);术后8 h,两组的Cor、NE水平高于本组术前,差异有统计学意义(P<0.05)。结论氢吗啡酮复合罗哌卡因用于髋关节置换术后自控镇痛效果较好,能明显降低患者术后疼痛程度,调节炎症因子水平,对应激反应影响小。

Objective To explore the effect of automatic analgesia administered to Hydromorphone compound Ropivacaine after hip replacement and its effect on inflammatory factors.Methods A total of 110 patients underwent hip replacement in Qianjiang Central Hospital from February 2019 to June 2020 were selected as the study subjects and divided into the observation group and the control group according to the random number table method,with 55 cases in each group.The control group was given Morphine Hydrochloride combined with Ropivacaine for self-controlled analgesia,and the observation group was given Hydromorphone combined with Ropivacaine for self-controlled analgesia.The levels of pain,inflammatory factors and stress response were compared between the two groups.Results The visual analogue scales(VAS)scores at 8,12 and 24 hours after the operation of the two groups were lower than those at postoperative 4 hours in the group,with statistically significant differences(P<0.05).At 8,12 and 24 hours after the operation,the VAS scores in the observation group were lower than those in the control group at the same period,with statistically significant differences(P<0.05).Before the operation,there were no statistically significant differences of interleukin-6(IL-6),interleukin-10(IL-10),and tumor necrosis factor-α(TNF-α)levels between the two groups(P>0.05).At 8 hours after the operation,the IL-6,TNF-αlevels in the observation group were lower than those in the control group at the same period,with statistically significant differences(P<0.05).At 8 hours after the operation,the IL-10 level in the observation group was higher than that in the control group at the same period,with statistically significant difference(P<0.05).At 8 hours after the operation,the IL-6,TNF-αlevels in the both group were higher than those before the operation in the group,with statistically significant differences(P<0.05).At 8 hours after the operation,the IL-10 level in the both group were higher than those before the operation in the group,with statistically significant differences(P<0.05).Before the operation,there were no statistically significant differences of cortisol(Cor)and noradrenaline(NE)levels between the two groups(P>0.05).At 8 hours after the operation,the Cor,NE levels in the observation group were lower than those in the control group at the same period,with statistically significant differences(P<0.05).At 8 hours after the operation,the Cor,NE levels in the both group were higher than those before the operation in the group,with statistically significant differences(P<0.05).Conclusion Hydromorphone combined with ropivacaine has a good effect on self-controlled analgesia after hip joint replacement,which can significantly reduce postoperative pain,regulate the level of inflammatory factors,and have little effect on stress response.