摘要
目的:观察地佐辛联合罗哌卡因对全膝关节置换术(TKA)后患者的疼痛与炎性因子表达及短期认知功能的影响。方法:择期行TKA患者102例随机分为联合组(n=51)和罗哌卡因组(n=51)。两组均采取全麻。罗哌卡因组患者在假体安放完成后予0.3%g·L^(-1)罗哌卡因50 ml+0.05 mg肾上腺素局部浸润;联合组患者切皮前予地佐辛0.1 mg·kg^(-1)iv,其他治疗与罗哌卡因组相同。观察两组术后舒芬太尼用量、追加镇痛患者比例、药品不良反应,比较两组患者麻醉诱导前(T0)、术后6 h(T1)、术后12 h(T2)、术后24 h(T3)的血清疼痛因子[P物质(SP)、5-羟色胺(5-HT)、组胺(HIS)]、炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)]水平变化,以及T1、T2、T3时静息、运动的视觉模拟量表(VAS)评分,T0、T3、术后3 d、术后7 d简易精神状态评价量表(MMSE)评分变化,和术后7 d认知功能障碍(POCD)发生率。结果:联合组术后舒芬太尼用量、补救镇痛比例均低于罗哌卡因组(P<0.05)。联合组患者T1、T2、T3时血清SP、5-HT、HIS、TNF-α、IL-6、IL-1β水平低于罗哌卡因组(P<0.05);T1、T2、T3时静息、运动VAS评分低于罗哌卡因组(P<0.05);T3、术后3 d、术后7 d的MMSE评分高于罗哌卡因组(P<0.05);联合组术后7 d POCD发生率低于罗哌卡因组(P<0.05)。两组药品不良反应发生率差异无统计学意义(P>0.05)。结论:地佐辛联合罗哌卡因用于TKA患者,可降低血清疼痛与炎性因子表达,减少术后镇痛药物用量,降低术后POCD发生率,值得临床推广。
Objective:To investigate the effects of dizoxin combined with ropivacaine on the expressions of postoperative pain inflammatory factors and short-term cognitive function in patients with total knee arthroplasty (TKA).M ethods:Totally 1 0 2 patients with elective TKA were divided into combined group (n=5 1) and ropivacaine group (n=5 1) at random.Both groups were treated with general anesthesia,and the combined group was given intravenous injection of 0.1 mg·kg^(-1)dizoxin before skin incision,and after the implant placement,3.0 g·L^(-1)ropivacaine 5 0 ml+0.0 5 mg epinephrine was infused locally,and ropivacaine group was given local infiltration of 3.0 g·L^(-1)ropivacaine 5 0 ml+0.0 5 mg epinephrine only after implant placement.The postoperative sufentanil dosage,proportion of patients taking remedial analgesia,and adverse reactions,as well as serum pain factors[substance P (SP),serotonin (5-HT),histamine (HIS)],inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6 (IL-6),interleukin-1β(IL-1β)]levels before substance induction (T0),6 hours after operation (T1),12 hours after operation (T2),24 hours after operation (T3),and the resting,visual analogue scale (VAS) scores of T1,T2and T3,the scores of the Mini-Mental state assessment scale(MMSE) at T0and T3,and on the 3rd and 7th day after operation,and the incidence of cognitive dysfunction (POCD) on the 7 th day after surgery were compared between the two groups.Results:The amount of sufentanil and the proportion taking remedial analgesia after operation in the combined group were lower than those in ropivacaine group (P<0.05);the serum SP,5-HT and HIS levels,and the levels of serum TNF-α,IL-6 and IL-1βin the combined group at T1,T2and T3were lower than those in ropivacaine group (P<0.05);the resting and exercise VAS scores at T1,T2and T3in the combined group were lower than those in ropivacaine group (P<0.05);the MMSE scores at T3and on the 3rd and 7th day after operation in the combined group were higher than those in ropivacaine group (P<0.05);the difference in the incidence of adverse reactions between the two groups was not statistically significant (P>0.05);on the 7th postoperative day,the incidence of POCD in the combined group was lower than that in ropivacaine group (P<0.05).Conclusion:Dezocin combined with ropivacaine used in TKA patients can reduce the expressions of serum pain inflammatory factors,reduce the amount of postoperative analgesic drugs and reduce the incidence of postoperative POCD,which is worthy of clinical promotion.
作者
舒波
张引
江峰
高田
Shu Bo;Zhang Yin;Jiang Feng;Gao Tian(Department of Anesthesiology,the First People*s Hospital of Bengbu,Anhui Bengbu 233000,China;Department of Anesthesiology,the First Affiliated Hospital of Bengbu Medical College)
出处
《中国药师》
CAS
2021年第2期313-316,358,共5页
China Pharmacist
关键词
地佐辛
罗哌卡因
全膝关节置换术
疼痛因子
炎性因子
短期认知功能
Dezocine
Ropivacaine
Total knee replacement
Pain factor
Inflammatory factor
Short-term cognitive function
