地塞米松联合右美托咪定对髋关节置换术老年病人的镇痛观察

Analgesia of dexamethasone combined with dexmedetomidine in elderly patients undergoing hip arthroplasty

目的 探讨地塞米松联合右美托咪定对行髋关节置换术老年病人术后疼痛效果。方法 选取2020年2月至2022年2月沧州市中心医院收治的80例行髋关节置换术的老年病人,按照随机数字表法分为观察组(n=40)和对照组(n=40)。对照组于麻醉诱导前泵注右美托咪定1μg/kg,时间为10 min,之后调整剂量为0.5μg·kg^(-1)·h^(-1),直至术前30 min。观察组则在采用右美托咪定泵注的同时静脉注射5 mg地塞米松。对比两组病人术后疼痛程度、肾功能指标[血肌酐(Scr)、尿素氮(BUN)]及血清前列腺素E2(PGE2)、白细胞介素-6(IL-6)、细胞间黏附分子-1(ICAM-1)、C-反应蛋白(CRP)水平。结果 观察组病人术后12h、术后24 h的视觉模拟评分法(VAS)评分均低于对照组(P<0.05);两组术后1 h、24 h,Scr、BUN、PGE2、IL-6、ICAM-1、CRP水平在组间、时间及交互方面进行比较,差异有统计学意义(P<0.05);手术后1 h,观察组Scr、BUN水平分别为(65.33±8.06)μmol/L、(5.64±0.78)mmol/L;手术后24 h,观察组Scr、BUN、PGE2、IL-6、ICAM-1、CRP水平分别为(69.07±8.08)μmol/L、(6.06±0.88)mmol/L、(17.76±2.65)μg/L、(62.38±7.43)ng/L、(283.35±37.65)μg/L、(10.39±1.33)mg/L;手术后1 h,对照组Scr、BUN水平分别为(69.76±7.96)μmol/L、(6.16±0.86)mmol/L;手术后24 h,对照组Scr、BUN、PGE2、IL-6、ICAM-1、CRP水平分别为(69.76±7.96)μmol/L、(6.58±0.93)mmol/L、(22.73±3.36)μg/L、(79.48±9.34)ng/L、(326.86±42.45)μg/L、(14.22±1.84)mg/L。观察组术后1 h、术后24 h的Scr、BUN、PGE2、IL-6、ICAM-1、CRP水平均低于对照组(P<0.05)。结论 地塞米松联合右美托咪定能够减轻髋关节置换术老年病人术后疼痛程度,减轻肾功能损伤、降低炎症反应。

Objective To investigate the effect of dexamethasone combined with dexmedetomidine on postoperative pain in elderly patients undergoing hip replacement.Methods Eighty elderly patients undergoing hip replacement in Cangzhou Central Hospital from February 2020 to February 2022 were selected and randomly assigned into observation group(n=40)and control group(n=40)accord-ing to random number table method.The control group was injected with 1µg/kg dexmedetomidine for 10 min before anesthesia induc-tion,and then the dose was adjusted to 0.5µg·kg^(-1)·h^(-1) until 30 min before surgery.The observation group received dexmedetomidine pumping and intravenous injection of 5 mg dexamethasone.A comparison was made of the postoperative pain degree,renal function in-dexes[serum creatinine(Scr),blood urea nitrogen(BUN)]and the levels of serum prostaglandin E2(PGE2),interleukin-6(IL-6),inter-cellular adhesion molecule-1(ICAM-1)and C-reactive protein(CRP)between the two groups.Results The visual analog scale(VAS)scores of the observation group were lower than those of the control group at 12 h and 24 h after operation(all P<0.05).The levels of Scr,BUN,PGE2,IL-6,ICAM-1 and CRP at 1 h and 24 h after operation were compared between the two groups,and the differences were statistically significant in terms of time and interaction(P<0.05).One hour after operation,the levels of Scr and BUN in the obser-vation group were(65.33±8.06)µmol/L and(5.64±0.78)mmol/L,respectively.Twenty-four hours after surgery,the levels of Scr,BUN,PGE2,IL-6,ICAM-1 and CRP in the observation group were(69.07±8.08)µmol/L,(6.06±0.88)mmol/L,(17.76±2.65)µg/L,(62.38±7.43)ng/L,(283.35±37.65)µg/L,and(10.39±1.33)mg/L,respectively.One hour after operation,the levels of Scr and BUN in the con-trol group were(69.76±7.96)µmol/L and(6.16±0.86)mmol/L,respectively.Twenty-four hours after surgery,the levels of Scr,BUN,PGE2,IL-6,ICAM-1 and CRP in the control groupwere(69.76±7.96)µmol/L,(6.58±0.93)mmol/L,(22.73±3.36)µg/L,(79.48±9.34)ng/L,(326.86±42.45)µg/L and(14.22±1.84)mg/L,respectively.The levels of Scr,BUN,PGE2,IL-6,ICAM-1 and CRP in the observa-tion group at 1 h and 24 h after surgery were lower than those in the control group(P<0.05).Conclusion Dexamethasone combined with dexmedetomidine can reduce postoperative pain,renal function damage and inflammatory response in elderly patients undergoing hip replacement.