酒石酸布托啡诺复合地佐辛用于全髋置换术后自控镇痛的效果观察
|
摘要
目的观察酒石酸布托啡诺复合地佐辛应用于全髋置换术后自控镇痛的效果。方法采用回顾性研究,选择2015年8月到2018年1月在湖北医药学院附属东风医院择期行全髋置换术的患者58例作为研究对象,根据术后镇痛药物的不同分为观察组30例与对照组28例,2组在手术中都采用腰-硬联合麻醉,对照组给予术后地佐辛硬膜外自控镇痛,观察组给予术后酒石酸布托啡诺复合地佐辛硬膜外自控镇痛,记录2组镇痛效果与预后情况。结果观察组术后2,6,12,24 h的疼痛VAS评分都显著低于对照组(P<0.05)。术后不同时间点,2组在Ramsay镇静评分方面没有明显差异。在术后的尿潴留、瘙痒、呼吸抑制、恶心呕吐等不良反应发生率上,观察组为6.7%,对照组为53.6%,观察组显著低于对照组(P<0.05)。2组术前1 d肾上腺素与去甲肾上腺素对比无显著差异,术后24 h都显著增加,术后72 h逐渐恢复到术前1 d水平,观察组的波动幅度显著小于对照组(P<0.05)。结论地佐辛联合酒石酸布托啡诺应用于全髋置换术后自控镇痛能在保持镇静效果的基础上提高镇痛效果,缓解机体应激反应,减少术后不良反应的发生率。
OBJECTIVE To observe theanalgesia effects of bhutto butorphanol tartrate combined dezocine in the patients after total hip replacement. METHODS From August 2015 to January 2018, used the retrospective research methods, 58 patients underwent total hip replacement were selected in Dongfeng Hospital Affiliated to Hubei University of Medicine as the research object, all the patients were divided into the observation group of 30 patients and the control group of 28 patients accorded to the different postoperative analgesic drugs, two groups were given the combined spinal epidural anesthesia, the control group were given postoperative dezocine epidural analgesia, the observation group were given postoperative bhutto butorphanol tartrate combined dezocine epidural analgesia, recorded two groups of analgesic effect and prognosis. RESULTS The postoperative 2, 6, 12 and 24 h pain VAS scores in the observation group were significantly less than those in the control group(P<0.05). There were no significant difference in the contrast of Ramsay scores at different time points between the two groups. The incidence of adverse reactions of postoperative such as urinary retention, itching, respiratory depression, nausea and vomiting was 6.7% in the observation group, while it was 53.6% in the control group. The incidence in the observation group were significantly lower than that in the control group(P<0.05). There were no significant difference between the two groups in preoperative 1 d adrenaline and norepinephrine, and at postoperative 24 h they were increased significantly, and at postoperative72 h they were gradually returned to the level of preoperative 1 d. The fluctuation amplitude of the observation group were significantly less than that of the control group(P<0.05). CONCLUSION The bhutto butorphanol tartrate combined dezocine for postoperative analgesia in patients undergoing total hip replacement can enhance the analgesic effect in maintaining sedative effect, relieve stress response, reduce the incidence of adverse reactions after operation.
OBJECTIVE To observe theanalgesia effects of bhutto butorphanol tartrate combined dezocine in the patients after total hip replacement. METHODS From August 2015 to January 2018, used the retrospective research methods, 58 patients underwent total hip replacement were selected in Dongfeng Hospital Affiliated to Hubei University of Medicine as the research object, all the patients were divided into the observation group of 30 patients and the control group of 28 patients accorded to the different postoperative analgesic drugs, two groups were given the combined spinal epidural anesthesia, the control group were given postoperative dezocine epidural analgesia, the observation group were given postoperative bhutto butorphanol tartrate combined dezocine epidural analgesia, recorded two groups of analgesic effect and prognosis. RESULTS The postoperative 2, 6, 12 and 24 h pain VAS scores in the observation group were significantly less than those in the control group(P<0.05). There were no significant difference in the contrast of Ramsay scores at different time points between the two groups. The incidence of adverse reactions of postoperative such as urinary retention, itching, respiratory depression, nausea and vomiting was 6.7% in the observation group, while it was 53.6% in the control group. The incidence in the observation group were significantly lower than that in the control group(P<0.05). There were no significant difference between the two groups in preoperative 1 d adrenaline and norepinephrine, and at postoperative 24 h they were increased significantly, and at postoperative72 h they were gradually returned to the level of preoperative 1 d. The fluctuation amplitude of the observation group were significantly less than that of the control group(P<0.05). CONCLUSION The bhutto butorphanol tartrate combined dezocine for postoperative analgesia in patients undergoing total hip replacement can enhance the analgesic effect in maintaining sedative effect, relieve stress response, reduce the incidence of adverse reactions after operation.
引文
[1]SUZUKI T,NAKAMURA Y,KATO H.Effects of denosumab on bone metabolism and bone mineral density with anti-TNFinhibitors,tocilizumab,or abatacept in osteoporosis with rheumatoid arthritis[J].Ther Clin Risk Manag,2018,14(1):453-459.
[2]小辉,张霞婧,冯燕,等.酒石酸布托啡诺与地佐辛用于腹腔镜子宫肌瘤切除术后镇痛效果比较[J].陕西医学杂志,2017,46(6):801-802.
[3]WANG C,MENG H Y,WANG Y,et al.Analysis of early stage osteonecrosis of the human femoral head and the mechanism of femoral head collapse[J].Int J Biol Sci,2018,14(2):156-164.
[4]NAKAMURA Y,SUZUKI T,KATO H.Serum bone alkaline phosphatase is a useful marker to evaluate lumbar bone mineral density in Japanese postmenopausal osteoporotic women during denosumab treatment[J].Ther Clin Risk Manag,2017,13:1343-1348.
[5]屠苏,曹赋韬,范晓春,等.盐酸右美托咪定联合酒石酸布托啡诺对机械通气患者的镇痛镇静效果[J].安徽医学,2018,39(1):84-86.
[6]J?RGENSEN H S,WINTHER S,B?TTCHER M,et al.Bone turnover markers are associated with bone density,but not with fracture in end stage kidney disease:a cross-sectional study[J].BMC Nephrol,2017,18(1):284.
[7]LI Z H,WANG L P,HE Z J,et al.Dezocine combined with low-dose naloxone for postoperative analgesia in radical thyroidectomy[J].Chin J New Drugs(中国新药杂志),2016,25(5):558-561.
[8]YANG G X,CHEN X Y,YAN Z,et al.CD11b promotes the differentiation of osteoclasts induced by RANKL through the spleen tyrosine kinase signalling pathway[J].J Cell Mol Med,2017,21(12):3445-3452.
[9]MUKKA S S,ANDERSSON G N,HULTENBY K R,et al.Osteoclasts in periprosthetic osteolysis:the charnley arthroplasty revisited[J].J Arthroplasty,2017,32(10):3219-3227.
[10]LIU J Y,SI L J.Effects of butorphanol pretreatment on myocardial ischemia-reperfusion injury and it's mechanisms in mice[J].J Southeast Univ Med Sci Ed(东南大学学报:医学版),2017,36(1):74-77.
[11]LAIRD E,MOLLOY A M,MCNULTY H,et al.Greater yogurt consumption is associated with increased bone mineral density and physical function in older adults[J].Osteoporos Int,2017,28(8):2409-2419.
[12]NAKAMURA Y,SUZUKI T,KAMIMURA M,et al.Alfacalcidol increases the therapeutic efficacy of ibandronate on bone mineral density in Japanese women with primary osteoporosis[J].Tohoku J Exp Med,2017,241(4):319-326.
[13]王祝东.酒石酸布托啡诺复合丙泊酚用于无痛结肠镜的麻醉效果观察[J].浙江实用医学,2017,22(1):52-53,65.
[14]DAVYDOV D A,AVDALYAN A M,AGADZHANYAN VV,et al.Morphometric and molecular biological features of femoral head tissue in different nosological entities of coxarthrosis[J].Arkh Patol,2016,78(5):20-26.
[15]HOOSHMAND S,KERN M,METTI D,et al.The effect of two doses of dried plum on bone density and bone biomarkers in osteopenic postmenopausal women:a randomized,controlled trial[J].Osteoporos Int,2016,27(7):2271-2279.
[16]GAO T Q,ZHANG Q Y,MA Y B,et al.Comparison of the efficacy of propofol respectively combined with fentanyl,dezocine and butorphanol for painless gastroscopy[J].J Pharm Res(药学研究),2017,36(2):115-117.
[17]IBA K,SONODA T,TAKADA J,et al.Further significant effects of eldecalcitol on bone resorption markers and bone mineral density in postmenopausal osteoporosis patients having undergone long-term bisphosphonate treatment[J].JBone Miner Metab,2017,35(2):171-176.
[18]许军,张联义.右美托咪定复合布托啡诺对股骨近端防旋髓内钉内固定术后静脉镇痛的临床观察[J].中国临床研究,2017,30(6):819-821.
[19]ORMSBY R T,CANTLEY M,KOGAWA M,et al.Evidence that osteocyte perilacunar remodelling contributes to polyethylene wear particle induced osteolysis[J].Acta Biomater,2016,33:242-251.
[20]MUKAIYAMA K,UCHIYAMA S,NAKAMURA Y,et al.Eldecalcitol,in combination with bisphosphonate,is effective for treatment of Japanese osteoporotic patients[J].Tohoku JExp Med,2015,237(4):339-343.
[21]WU F T,LASLETT L L,ZHANG Q.Threshold effects of vitamin D status on bone health in Chinese adolescents with low calcium intake[J].J Clin Endocrinol Metab,2015,100(12):4481-4489.
[22]CHEN Y J,WANG Y S.Research progress in protective effect of butorphanol tartrate against myocardial oxidative stress injury[J].Med Recapitul(医学综述),2017,23(14):2824-2827,2832.
[23]WANG Z H,LIU N C,ZHOU G,et al.Expression of XBP1s in fibroblasts is critical for TiAl6 V4 particle-induced RANKLexpression and osteolysis[J].J Orthop Res,2017,35(4):752-759.
[24]WANG Z H,LIU N C,SHI T G,et al.ER stress mediates TiAl6V4 particle-induced peri-implant osteolysis by promoting RANKL expression in fibroblasts[J].PLoS One,2015,10(9):e0137774.DOI:10.1371/journal.pone.0137774.
[2]小辉,张霞婧,冯燕,等.酒石酸布托啡诺与地佐辛用于腹腔镜子宫肌瘤切除术后镇痛效果比较[J].陕西医学杂志,2017,46(6):801-802.
[3]WANG C,MENG H Y,WANG Y,et al.Analysis of early stage osteonecrosis of the human femoral head and the mechanism of femoral head collapse[J].Int J Biol Sci,2018,14(2):156-164.
[4]NAKAMURA Y,SUZUKI T,KATO H.Serum bone alkaline phosphatase is a useful marker to evaluate lumbar bone mineral density in Japanese postmenopausal osteoporotic women during denosumab treatment[J].Ther Clin Risk Manag,2017,13:1343-1348.
[5]屠苏,曹赋韬,范晓春,等.盐酸右美托咪定联合酒石酸布托啡诺对机械通气患者的镇痛镇静效果[J].安徽医学,2018,39(1):84-86.
[6]J?RGENSEN H S,WINTHER S,B?TTCHER M,et al.Bone turnover markers are associated with bone density,but not with fracture in end stage kidney disease:a cross-sectional study[J].BMC Nephrol,2017,18(1):284.
[7]LI Z H,WANG L P,HE Z J,et al.Dezocine combined with low-dose naloxone for postoperative analgesia in radical thyroidectomy[J].Chin J New Drugs(中国新药杂志),2016,25(5):558-561.
[8]YANG G X,CHEN X Y,YAN Z,et al.CD11b promotes the differentiation of osteoclasts induced by RANKL through the spleen tyrosine kinase signalling pathway[J].J Cell Mol Med,2017,21(12):3445-3452.
[9]MUKKA S S,ANDERSSON G N,HULTENBY K R,et al.Osteoclasts in periprosthetic osteolysis:the charnley arthroplasty revisited[J].J Arthroplasty,2017,32(10):3219-3227.
[10]LIU J Y,SI L J.Effects of butorphanol pretreatment on myocardial ischemia-reperfusion injury and it's mechanisms in mice[J].J Southeast Univ Med Sci Ed(东南大学学报:医学版),2017,36(1):74-77.
[11]LAIRD E,MOLLOY A M,MCNULTY H,et al.Greater yogurt consumption is associated with increased bone mineral density and physical function in older adults[J].Osteoporos Int,2017,28(8):2409-2419.
[12]NAKAMURA Y,SUZUKI T,KAMIMURA M,et al.Alfacalcidol increases the therapeutic efficacy of ibandronate on bone mineral density in Japanese women with primary osteoporosis[J].Tohoku J Exp Med,2017,241(4):319-326.
[13]王祝东.酒石酸布托啡诺复合丙泊酚用于无痛结肠镜的麻醉效果观察[J].浙江实用医学,2017,22(1):52-53,65.
[14]DAVYDOV D A,AVDALYAN A M,AGADZHANYAN VV,et al.Morphometric and molecular biological features of femoral head tissue in different nosological entities of coxarthrosis[J].Arkh Patol,2016,78(5):20-26.
[15]HOOSHMAND S,KERN M,METTI D,et al.The effect of two doses of dried plum on bone density and bone biomarkers in osteopenic postmenopausal women:a randomized,controlled trial[J].Osteoporos Int,2016,27(7):2271-2279.
[16]GAO T Q,ZHANG Q Y,MA Y B,et al.Comparison of the efficacy of propofol respectively combined with fentanyl,dezocine and butorphanol for painless gastroscopy[J].J Pharm Res(药学研究),2017,36(2):115-117.
[17]IBA K,SONODA T,TAKADA J,et al.Further significant effects of eldecalcitol on bone resorption markers and bone mineral density in postmenopausal osteoporosis patients having undergone long-term bisphosphonate treatment[J].JBone Miner Metab,2017,35(2):171-176.
[18]许军,张联义.右美托咪定复合布托啡诺对股骨近端防旋髓内钉内固定术后静脉镇痛的临床观察[J].中国临床研究,2017,30(6):819-821.
[19]ORMSBY R T,CANTLEY M,KOGAWA M,et al.Evidence that osteocyte perilacunar remodelling contributes to polyethylene wear particle induced osteolysis[J].Acta Biomater,2016,33:242-251.
[20]MUKAIYAMA K,UCHIYAMA S,NAKAMURA Y,et al.Eldecalcitol,in combination with bisphosphonate,is effective for treatment of Japanese osteoporotic patients[J].Tohoku JExp Med,2015,237(4):339-343.
[21]WU F T,LASLETT L L,ZHANG Q.Threshold effects of vitamin D status on bone health in Chinese adolescents with low calcium intake[J].J Clin Endocrinol Metab,2015,100(12):4481-4489.
[22]CHEN Y J,WANG Y S.Research progress in protective effect of butorphanol tartrate against myocardial oxidative stress injury[J].Med Recapitul(医学综述),2017,23(14):2824-2827,2832.
[23]WANG Z H,LIU N C,ZHOU G,et al.Expression of XBP1s in fibroblasts is critical for TiAl6 V4 particle-induced RANKLexpression and osteolysis[J].J Orthop Res,2017,35(4):752-759.
[24]WANG Z H,LIU N C,SHI T G,et al.ER stress mediates TiAl6V4 particle-induced peri-implant osteolysis by promoting RANKL expression in fibroblasts[J].PLoS One,2015,10(9):e0137774.DOI:10.1371/journal.pone.0137774.