摘要
目的探究氢吗啡酮超前镇痛对股骨骨折患者术后应激反应和认知功能的影响。方法选择2014年12月至2016年6月本院收治并行手术治疗的股骨骨折患者98例为研究对象。采用随机数表法将其分为试验组和对照组,每组各49例。试验组患者在全身麻醉诱导前予以氢吗啡酮静脉注射,对照组患者予以等量的生理盐水静脉注射。比较两组患者术前及术后不同时间点简易精神状况检查(mini-mental state examination,MMSE)评分,炎性因子和应激激素水平,视觉模拟评分法(visual analogue scale,VAS)评分及术中和术后舒芬太尼、地佐辛补救用药情况。结果术前两组患者MMSE评分比较无显著差异(P>0.05);术毕及术后2小时、24小时、3天,试验组患者MMSE评分均显著高于同时间点对照组患者(P<0.05)。术前两组患者炎性因子和应激激素水平比较均无显著差异(P>0.05)。术毕及术后12、24小时,试验组患者白介素-6、白介素-8、肿瘤坏死因子-α、皮质醇及血管紧张素Ⅱ水平均显著低于对照组(P<0.05)。术后2、4、6、12、24小时,试验组患者VAS评分均显著低于对照组(P<0.05)。试验组患者舒芬太尼使用量显著少于对照组(P<0.05),地佐辛补救用药率显著低于对照组(P<0.05)。结论氢吗啡酮超前镇痛能够减轻股骨骨折患者术后应激反应,降低炎性因子水平,有效改善患者术后认知功能。
Objective To investigate the effect of Hydromorphone preemptive analgesia on stress response,inflammatory mediators and cognitive function in patients after femoral fracture surgery.Method98patients with femoral fracture treated with surgery from December2014to June2016in our hospital were selected as the study objects.They were randomly divided into experimental group and control group,49cases in each group.Experimental group patients were given intravenous infusion of Hydromorphone before induction of general anesthesia,control group patients received the same dose of saline intravenously.The mini-mental state examination(MMSE)score,inflammatory mediators and stress hormone levels,visual analogue scale(VAS)scores before and after operation at different time points and postoperative Sufentanil,Dezocine remedial medication between the two groups were compared.Result There was no significant difference in MMSE scores between the two groups(P>0.05).The MMSE scores of experimental group were significantly higher than those of control group immediately after operation and2hours,24hours and3days after operation(P<0.05).There were no significant differences in inflammatory mediators and stress hormone levels between the two groups(P>0.05).The levels of interleukin(IL)-6,IL-8,tumor necrosis factor-α,cortisoland angiotensinⅡof experimental group were significantly lower than those of control group immediately after operation and12and24hours postoperatively(P<0.05).The VAS scores in experimental group was significantly lower than those in control group(P<0.05).The dosage of Sufentanil in experimental group was significantly lower than control group(P<0.05),the remedy rate of Dizocine was significantly lower than control group(P<0.05).Conclusion Hydromorphone preemptive analgesia after surgery can relieve postoperative stress response,reduce the levels of inflammatory factors,effectively improve postoperative cognitive function.
作者
王彦强
罗远国
WANG Yan-qiang;LUO Yuan-guo(Department of Anesthesiology, 181st Hospital of Chinese People's Liberation Army, Guangxi, Guilin 541002, China)
出处
《中国医学前沿杂志（电子版）》
2017年第6期43-46,共4页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
关键词
氢吗啡酮
超前镇痛
股骨骨折
认知功能
应激
Hydromorphone
Preemptive analgesia
Femoral fracture
Cognitive function
Stress
