| 史青梅,阙红波,王守义,戚洪亮,邓雪峰.持续泵注小剂量右美托咪定联合舒芬太尼对老年下肢骨折手术患者镇痛、炎症反应和认知功能的影响[J].,2023,(6):1105-1109 |
| 持续泵注小剂量右美托咪定联合舒芬太尼对老年下肢骨折手术患者镇痛、炎症反应和认知功能的影响 |
| Effects of Continuous Pump Infusion of Low-dose Dexmedetomidine Combined with Sufentanil on Analgesia, Inflammatory Response and Cognitive Function in Elderly Patients Undergoing Lower Limb Fracture Surgery |
| 投稿时间：2022-07-23 修订日期：2022-08-18 |
| DOI：10.13241/j.cnki.pmb.2023.06.021 |
| 中文关键词: 右美托咪定 舒芬太尼 自控静脉镇痛 下肢骨折手术 |
| 英文关键词: Dexmedetomidine Sufentanil Patient controlled intravenous analgesia Lower limb fracture surgery |
| 基金项目:安徽省普通高校重点实验室项目（MZKF202002） |
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| 中文摘要: |
| 摘要 目的：比较术后持续泵注不同剂量右美托咪定联合舒芬太尼对行手术治疗的下肢骨折老年患者的镇痛效果以及对炎症反应和认知功能的影响。方法：采用随机数字表法将2020年10月到2022年6月期间在我院骨科接受手术治疗的60例老年下肢骨折患者分为对照组和观察组，各30例。对照组患者在术后通过电子镇痛泵持续泵注0.03 μg/（kg?h）舒芬太尼注射液，观察组在术后持续泵注0.03 μg/（kg?h）舒芬太尼注射液+0.06 μg/（kg?h）。记录患者术后自控给药次数、苏醒时间、谵妄发生情况。比较两组患者术后3 h、6 h、12 h、24 h和48 h疼痛数字等级评分（NRS），采用酶联免疫吸附法检测术前、术后12 h和术后24 h时γ-干扰素（IFN-γ）、白细胞介素-4（IL-4）、P物质（SP）、一氧化氮（NO）和内啡肽β（β-EP）水平。采用蒙特利尔认知评估量表（MoCA）和简易智力状态测定表（MMSE）评估患者术前以及术后24 h、48 h时的认知功能。结果：（1）观察组术后谵妄发生例数显著少于对照组，苏醒时间也显著短于对照组（P<0.05）；（2）观察组术后3 h、6 h、12 h、24 h和48 h的NRS评分均显著低于对照组（P<0.05）；（3）观察组术后24 h和48 h时的IFN-γ和Th1/Th2显著高于对照组（P<0.05）；（4）观察组术后24 h和48 h时血清SP、NO和β-EP水平均显著低于对照组（P<0.05）。（5）观察组患者术后24 h和48 h的MoCA评分和MMSE评分均显著高于对照组（P<0.05）。结论：老年下肢手术患者在术后持续泵注小剂量右美托咪定联合舒芬太尼阵痛效果良好，能够显著减少疼痛物质释放，平衡免疫功能，改善认知功能。 |
| 英文摘要: |
| ABSTRACT Objective: To compare the analgesic effect of continuous pump infusion of different doses of dexmedetomidine combined with sufentanil on elderly patients with lower limb fractures who underwent surgery, as well as the effects on inflammatory response and cognitive function. Methods: Using the random number table method, 60 elderly patients with lower limb fractures who received surgical treatment in the Department of orthopaedics of our hospital from October 2020 to June 2022 were divided into control group and observation group, with 30 cases in each group. Patients in the control group were continuously injected with 0.03% by electronic analgesia pump after operation μg/ (kg?h) sufentanil injection, the observation group continued to pump 0.03 μg/ (kg?h) sufentanil injection +0.06 μg/(kg?h). The times of self-control administration, recovery time and delirium were recorded. The numerical rating scale (NRS) was compared between the two groups at 3 h, 6 h, 12 h, 24 h and 48 h after operation. The NRS was measured by enzyme-linked immunosorbent assay before operation, 12 h and 24 h after operation Interferon γ (IFN-γ), Interleukin-4(IL-4), Substance P (SP), nitric oxide (NO) and endorphins β (β-EP) level. Montreal Cognitive Assessment (MoCA) and mini mental state scale (MMSE) were used to evaluate the cognitive function of the patients before and 24 and 48 hours after operation. Results: (1) The number of postoperative delirium in the observation group was significantly less than that in the control group, and the recovery time was also significantly shorter than that in the control group (P<0.05); (2) The NRS scores of the observation group at 3 h, 6 h, 12 h, 24 h and 48 h after operation were significantly lower than those of the control group (P<0.05); (3) IFN at 24 h and 48 h after operation in the observation group-γ And th1/th2 were significantly higher than those in the control group (P<0.05); (4) Serum SP, no and β- EP levels were significantly lower than those in the control group (P<0.05). (5) The MOCA score and MMSE score of the observation group at 24 and 48 hours after operation were significantly higher than those of the control group (P<0.05). Conclusion: In elderly patients undergoing lower extremity surgery, continuous pumping of low-dose dexmedetomidine combined with sufentanil has a good effect on pain, which can significantly reduce the release of pain substances, balance immune function and improve cognitive function. |
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