帕瑞昔布超前镇痛联合术后硬膜外镇痛应用于髋关节置换术患者的临床观察

发布时间：2018-09-07 08:09

【摘要】：目的:观察帕瑞昔布超前镇痛联合术后硬膜外镇痛应用于髋关节置换术患者的效果及对机体免疫功能的影响。方法:选取2014年1月-2016年6月西宁市第三人民医院需行单侧髋关节置换术的患者86例,按随机数字表法分为观察组和对照组,各43例。两组患者均于腰硬联合麻醉下行单侧髋关节置换术,观察组患者于手术结束前30 min静脉给予注射用帕瑞昔布钠40mg,对照组患者静脉注射等量生理盐水;两组患者均于术后衔接硬膜外镇痛泵(盐酸罗哌卡因注射液150 mg+盐酸昂丹司琼注射液16mg+地佐辛注射液10mg,加生理盐水至100mL),滴注速度为2mL/h,自控泵注15min。比较两组患者不同时间点的血流动力学指标、镇痛效果、T淋巴细胞亚群和自然杀伤(NK)细胞水平,以及术后不良反应发生情况。结果:观察组有2例患者脱落,对照组有1例患者脱落。术前,两组患者平均动脉压(MAP)和心率(HR)比较,差异均无统计学意义(P0.05);术后12、24 h时,对照组患者MAP和HR均较术前显著升高,且显著高于观察组,差异均有统计学意义(P0.05);观察组患者各时间点MAP和HR与术前比较,以及两组患者手术结束即刻、术后48 h时的MAP和HR比较,差异均无统计学意义(P0.05)。手术结束即刻,两组患者VAS评分比较,差异均无统计学意义(P0.05);术后6、12、24、48 h时,观察组患者VAS评分显著低于对照组,差异均有统计学意义(P0.05)。术前,两组患者CD3~+、CD4~+、CD8~+、CD4~+/CD8~+和NK细胞水平比较,差异均无统计学意义(P0.05);两组患者手术结束即刻的CD3~+、CD4~+和NK细胞水平,两组患者术后12、24 h时的CD3~+、CD4~+、CD4~+/CD8~+和NK细胞水平,以及对照组患者术后48h时的CD3~+、CD4~+水平均较术前有显著变化,且观察组患者术后12、24 h时的CD3~+、CD4~+、CD4~+/CD8~+和NK细胞水平显著高于对照组,差异均有统计学意义(P0.05)。两组患者不良反应发生率比较,差异无统计学意义(P0.05)。结论:帕瑞昔布超前镇痛联合术后硬膜外镇痛对髋关节置换术患者镇痛效果好,使患者血流动力学稳定,且该方案对机体免疫功能具有一定的保护作用,安全性较好。
[Abstract]:Aim: to observe the effect of preemptive analgesia with paroxib combined with epidural analgesia on hip arthroplasty. Methods: 86 patients undergoing unilateral hip arthroplasty in Xining third people's Hospital from January 2014 to June 2016 were randomly divided into observation group (n = 43) and control group (n = 43). Patients in both groups were treated with unilateral hip replacement under combined spinal-epidural anesthesia. Patients in the observation group were given 40 mg of paroxib sodium intravenously 30 min before the end of operation, while the patients in the control group were given the same amount of normal saline intravenously. The epidural analgesia pump (ropivacaine hydrochloride injection 150 mg, ondansetron hydrochloride injection 16mg Dizosin injection 10 mg, normal saline to 100mL) was connected with epidural analgesia pump after operation. The infusion rate was 2 mL / h and the self-controlled pump was injected for 15 minutes. The hemodynamic indexes, T lymphocyte subsets and natural killer (NK) cells were compared between the two groups at different time points. Results: two patients in the observation group and one patient in the control group dropped off. There was no significant difference in mean arterial pressure (MAP) and heart rate (HR) between the two groups before operation (P0.05). At 1224 hours after operation, the MAP and HR in the control group were significantly higher than those before operation, and significantly higher than those in the observation group. The difference was statistically significant (P0.05); there was no significant difference in MAP and HR between the two groups at each time point between MAP and HR at the end of operation and 48 hours after operation (P0.05). At the end of the operation, there was no significant difference in VAS score between the two groups (P0.05), and the VAS score of the observation group was significantly lower than that of the control group (P0.05). Before operation, there was no significant difference between the two groups in the levels of CD3~ CD4 ~ / CD8 ~ / CD8 ~ and NK cells (P0.05). The levels of CD3~ CD4 ~ and NK cells in the two groups were significantly higher than those in the control group at 1224 h after operation, and the levels of CD3~ CD4 ~ / CD4 ~ / CD8 ~ and NK cells at 1224 h after operation in the two groups were not significantly different from those in the control group (P < 0.05), and there was no significant difference between the two groups (P0.05). The levels of CD3~ CD4- and NK cells in the control group were significantly higher than those in the control group at 48 h after operation (P0.05), and the levels of CD3~ CD4 ~ / CD8 ~ and NK cells in the observation group were significantly higher than those in the control group at 12h ~ 24 h after operation (P0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P0.05). Conclusion: preemptive analgesia combined with epidural analgesia has good analgesic effect on patients undergoing hip arthroplasty and stable hemodynamics.
【作者单位】：西宁市第三人民医院麻醉科;解放军306医院麻醉科;
【分类号】：R614

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