酒石酸布托啡诺对老年全髋关节置换手术后镇痛效果及炎症因子水平的影响

Effect of butorphanol tartrate on analgesia after total hip arthroplasty in the elderly and its effect on the levels of inflammatory factors

目的:探究酒石酸布托啡诺(butorphanol tartrate,BT)对老年全髋关节置换术(total hip arthroplasty,THA)后患者自控静脉镇痛的效果及对炎症因子水平的影响。方法:选取2018年8月至2019年8月在临泉县人民医院行THA的老年患者60例,30例接受BT作为自控静脉镇痛的患者入选观察组,30例接受舒芬太尼镇痛作为自控静脉镇痛的患者入选对照组。比较两组在术后4个不同时间点(术后6、12、24、36 h)的收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、心率(hear t rate,HR)、静息和动态疼痛视觉模拟评分(visual analog scale,VAS)、躁动-镇静程度量表(Richmond Agitation-Sedation Scale,RASS)评分、自控静脉镇痛泵有效按压次数和术后镇痛补救时间。观察不良反应的发生情况,测定术前、术后24 h炎症因子[白细胞介素-1β(interleukin-1β,IL-1β)、白细胞介素-6(interleukin-6,IL-6)、C反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子α(tumor necrosi s f actor-α,TNF-α)]水平的变化。结果:在术后各时间点,观察组的SBP、DBP和HR均显著高于对照组(P<0.05),观察组VAS评分均低于4分[VAS评分(静息):2.20~3.13,VAS评分(动态):2.64~3.97],随时间变化逐渐降低,且显著低于对照组[VAS评分(静息):2.96~4.37,VAS评分(动态):3.40~4.80,P<0.05]。在术后各时间点,两组患者的RASS评分均低于5,且随时间变化逐渐降低,观察组RASS评分(2.13~2.87)均显著低于对照组(1.56~2.27,P<0.05)。术后24 h,观察组炎症因子IL-1β[(31.68±3.23)mg/L vs(36.22±2.66)mg/L]、IL-6[(61.80±5.70)pg/mL vs(69.28±5.26)pg/mL]、CRP[(19.58±1.57)mg/L vs(24.72±2.28)mg/L]和TNF-α[(3.03±0.27)pg/mL vs(4.09±0.24)pg/mL]水平均显著低于对照组(均P<0.05)。对照组患者的自控静脉镇痛泵有效按压次数显著多于观察组[(4.37±2.06)h vs(6.33±1.89)h,P<0.05]。两组患者的首次补救镇痛时间没有明显差异(P>0.05),观察组的二次补救镇痛时间明显比对照组滞后[(15.73±3.12)h vs(11.79±2.95)h,P<0.05]。观察组、对照组不良反应总发生率比较差异无统计学意义(10.00%vs 16.67%,P>0.05)。结论:BT的自控静脉镇痛效果和镇静程度优于舒芬太尼,且安全性高。

Objective:To explore the effect of butorphanol tartrate(BT)on elderly patient-controlled intravenous analgesia after total hip arthroplasty(THA)and its effect on the levels of inflammatory factors.Methods:Sixty elderly patients who received THA at Linquan County People’s Hospital between August 2018 and August 2019 were enrolled.Thirty patients who received BT as patient-controlled intravenous analgesia were enrolled in the observation group.Thirty patients who received sufentanil analgesia as patient-controlled intravenous analgesia were included in the control group.At 4 different time points after the operation,the systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),visual analog scale(VAS),Richmond Agitation-Sedation Scale(RASS),the number of effective compressions of the patient-controlled intravenous analgesia pump,and the postoperative analgesic rescue time were compared between the 2 groups.The incidence of adverse reactions in the 2 groups was observed.The levels of interleukin-1β(IL-1β),interleukin-6(IL-6),C-reactive protein(CRP),and tumor necrosis factor-α(TNF-α)were observed before and after the surgery in the 2 groups.Results:SBP,DBP and HR in the observation group were significantly higher than those in the control group at all postoperative time points(P<0.05).VAS scores in the observation group,which gradually decreased with time,were all lower than 4 points[VAS score(resting):2.20–3.13,VAS score(dynamic):2.64–3.97],and were significantly lower than those in the control group[VAS score(resting):2.96–4.37,VAS score(dynamic):3.40–4.80,P<0.05].At each time point after the operation,the RASS scores of both groups were lower than 5 points,and gradually decreased with time.The RASS scores of the observation group(2.13–2.87)were significantly lower than those of the control group(1.56–2.27,P<0.05).Twenty-four hours after the surgery,the levels of inflammatory factors IL-1β[(31.68±3.23)mg/L vs(36.22±2.66)mg/L],IL-6[(61.80±5.70)pg/mL vs(69.28±5.26)pg/mL],CRP[(19.58±1.57)mg/L vs(24.72±2.28)mg/L]and TNF-α[(3.03±0.27)pg/mL vs(4.09±0.24)pg/mL]in the observation group were significantly lower than those in the control group(all P<0.05)The effective compression times of the patient-controlled intravenous analgesia pump in the control group were significantly more than those in the observation group[(4.37±2.06)h vs(6.33±1.89)h,P<0.05].The time of secondary rescue analgesia in the observation group was significantly slower than that in the control group[(15.73±3.12)h vs(11.79±2.95)h,P<0.05].There was no significant difference in the total incidence of adverse reactions between the 2 groups(10.00%vs 16.67%,P>0.05).Conclusion:As a self-controlled venous analgesia,BT has better analgesic effect and higher degree of sedation than sufentanil,and has high safety degree.