纳布啡联合舒芬太尼用于髋关节置换术老年患者术后镇痛对PI3K-Akt信号通路的影响

Effect of nalbuphine combined with sufentanil for postoperative analgesia in elderly patients undergoing hip replacement surgery on the PI3K Akt signaling pathway

目的探讨纳布啡联合舒芬太尼用于髋关节置换术老年患者术后镇痛对磷脂酰肌醇3激酶(PI3K)-蛋白激酶B(Akt)信号通路的影响。方法前瞻性选取2020年8月至2023年6月于西安市中医医院行髋关节置换术的老年患者82例,按随机数字表法将其分为观察组、对照组,每组各41例。对照组术后镇痛采用纳布啡,观察组术后镇痛采用纳布啡+舒芬太尼。比较两组术毕(T_(0))、镇痛即刻(T_(1))、镇痛5 min时(T_(2))血流动力学(舒张压、收缩压、心率)变化,比较两组术后2、12、24 h时视觉模拟评分法(VAS)评分及术前、术后1 d及术后3 d的简易智力状态检查量表(MMSE)评分,比较两组术前、术后1 d的PI3K、Akt水平及不良反应发生情况。结果T_(1)、T_(2)时,两组收缩压、舒张压水平有所上升,心率水平有所降低,且T_(2)时观察组收缩压、舒张压水平分别为(141.05±15.26)、(91.95±8.12)mmHg,均低于对照组[(147.85±15.24)、(97.52±8.95)mmHg],T_(1)、T_(2)时心率分别为(69.35±9.65)、(61.10±9.76)次/min,均高于对照组[(61.45±10.47)、(53.62±10.81)次/min],差异均有统计学意义(P<0.05)。观察组术后2、12、24 h的VAS评分分别为(1.32±0.19)、(1.88±0.21)、(2.15±0.32)分,均低于对照组[(1.46±0.24)、(2.41±0.35)、(2.83±0.46)分],差异均有统计学意义(P<0.05)。观察组术后1、3 d的MMSE评分分别为(25.81±1.65)、(27.06±1.22)分,均高于对照组[(23.72±1.47)、(25.33±2.65)分],差异均有统计学意义(P<0.05)。观察组术后1 d的PI3K、Akt蛋白水平分别为0.38±0.08、0.27±0.02,显著低于对照组(0.45±0.11、0.35±0.06),差异均有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论髋关节置换术老年患者术后镇痛采用纳布啡联合舒芬太尼可获得更稳定的血流动力学,并可有效改善老年患者术后认知功能,这可能与舒芬太尼可通过介导PI3K-Akt信号通路发挥抗细胞凋亡作用有关。

Objective To exploring the effect of nalbuphine combined with sufentanil for postoperative analgesia in elderly patients undergoing hip replacement surgery on the phosphoinositide 3-kinase(PI3K)-protein kinase B(Akt)signaling pathway.Methods A total of 82 elderly patients undergoing hip replacement in Xi'an Traditional Chinese Medicine Hospital from August 2020 to June 2023 were prospectively selected and divided into the observation group and the control group according to the random number table method,with 41 cases in each group.The control group received postoperative analgesia with nalbuphine,while the observation group received postoperative analgesia with nalbuphine and sufentanil.The changes in hemodynamics(diastolic blood pressure,systolic blood pressure,heart rate)at the end of surgery(T_(0)),immediately after analgesia(T_(1)),and at 5 minutes of analgesia(T_(2)),visual analogue scale(VAS)scores at 2,12,and 24 hours after surgery,mini mental state examination(MMSE)scores before surgery,1 day and 3 days after surgery,PI3K and Akt levels before surgery and 1 day after surgery,adverse reaction incidence rate were compared between two groups.Results At T_(1)and T_(2),the systolic blood pressure and diastolic blood pressure of the two groups increased,and the heart rate decreased.At T_(2),the systolic blood pressure and diastolic blood pressure of the observation group were(141.05±15.26)and(91.95±8.12)mmHg,respectively,which were lower than those of the control group[(147.85±15.24)and(97.52±8.95)mmHg],the heart rates at T_(1)and T_(2)were(69.35±9.65)and(61.10±9.76)times/min,respectively,which were higher than those in the control group[(61.45±10.47),(53.62±10.81)times/min],the differences were statistically significant(P<0.05).The VAS scores of the observation group at 2,12,and 24 hours after surgery were(1.3±0.19)(1.88±0.21),and(2.15±0.32)points,respectively,which were significantly lower than those of the control group[(1.46±0.24),(2.41±0.35),and(2.83±0.46)points],the differences were statistically significant(P<0.05).The MMSE scores of the observation group at 1 and 3 days after surgery were(25.81±1.65)and(27.06±1.22)points,respectively,which were significantly higher than those in the control group[(23.72±1.47)and(25.33±2.65)points],the differences were statistically significant(P<0.05).The levels of PI3K and Akt proteins in the observation group at 1 day after surgery were 0.38±0.08 and 0.27±0.02,respectively,which were significantly lower than those in the control group(0.45±0.11,0.35±0.06),the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Postoperative analgesia with nalbuphine combined with sufentanil can obtain more stable hemodynamics,and can effectively improve postoperative cognitive function in elderly patients,which may be related to the anti-apoptotic effect of sufentanil by mediating the PI3K-Akt signaling pathway.