摘要
目的 通过检测腰椎术后炎症因子水平、记录患者术后疼痛评分,探讨右美托咪定联合地塞米松对腰椎术后炎性反应和疼痛的影响.方法 选取腰椎手术患者85例,将其随机分为对照组(C组,n=20)、地塞米松组(Dex组,n=21)、右美托咪定组(Dxm组,n=22)和联合组(Dex+Dxm组,n=22).C组和Dex组在麻醉诱导前分别静脉注射生理盐水2 mL和地塞米松0.15 mg/kg;Dxm组麻醉诱导前以0.6 μg/(kg.h)泵速泵注右美托咪定,10 min后改为0.3 μg/(kg·h)的泵速维持至手术结束;而Dex+Dxm组在Dxm组的基础上,麻醉诱导前静脉注射地塞米松0.15 mg/kg.检测各组患者术前1天(T0)、术后第1 d(Ti)、第2d1(T2)、第3 d(T3)血清中白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)和肿瘤坏死因子-α(TNF-α)水平;记录各组患者术后8 h、T1、T2和T3静息与活动(VAS)评分.结果 术后炎症因子水平比较:与T0比较,4组患者血清中IL-1、1L-6、IL-10和TNF-α水平在T1时均显著升高(P＜0.05),Dex+Dxm组患者血清中IL-1、IL-6、IL-10和TNF-α水平在T1和T2时显著低于C组、Dex组和Dxm组(P＜0.05),Dex组和Dxm组血清中IL-1、IL-6、IL-10和TNF-α水平在T、T2和T3时比较差异无统计学意义(P＞0.05).术后VAS评分比较:Dex+Dxm组患者静息与活动VAS评分在术后8 h、T,、T2和T3时显著低于C组和Dex组(P＜0.05),在T2和T3时显著低于Dxm组(P＜0.05).结论 在腰椎手术中应用右美托咪定联合地塞米松可减轻患者术后炎症反应,改善患者术后急性疼痛.
Abstract
Objective To investigate the effect of dexmedetomidine combined with dexamethasone on the inflammatory re-sponse and pain after posterior lumbar interbody fusion.Methods 85 patients undergoing posterior lumbar interbody fusion were selected and randomly divided into control group(group C,n=20),dexamethasone group(group Dex,n=21),dexmedetomidine group(group Dxm,n=22)and combined group(group Dex+Dxm,n=22).In group C:2 ml of saline was injected intravenously before induction of anesthesia;in group Dex:0.15 mg/kg dexamethasone was injected intravenously before induction of anesthesia;In Dxm group:dexme-detomidine was pumped at a pump rate of 0.6 μg/(kg·h)before induction of anesthesia and changed to a pump rate of 0.3 μg/(kg·h)after 10 minutes until the end of surgery;in Dex+Dxm group:0.15 mg/kg dexamethasone was injected intravenously before induction of anesthesia and dexmedetomidine was pumped at a pump rate of 0.6 μg/(kg·h)after 10 minutes and changed to a pump rate of 0.3μg/(kg·h)until the end of surgery.The serum levels of IL-1,IL-6,IL-10 and TNF-α were measured at the pre-operative day(T0),the first postoperative day(T,),the second postoperative day(T2)and the third postoperative day(T3)in each group;the VAS scores were recorded at 8 hours,the first postoperative day(T1),the second postoperative day(T2)and the third postop-erative day(T3)in resting and active states.Results Comparison of postoperative inflammatory factor levels:compared with those at T0,serum levels of IL-1,IL-6,IL-10 and TNF-α counts were significantly higher in all four groups at T1(P＜0.05),serum levels of IL-1,IL-6,IL-10 and TNF-α counts in patients in the Dex+Dxm group were significantly lower at T1 and T2 than those in group C(P＜0.05),and the serum levels of IL-1,IL-6,IL-10 and TNF-α counts in the Dex and Dxm groups were not statistically different at T1,T2 and T3(P＞0.05);Comparison of postoperative VAS scores:compared with 8 hours postoperatively,VAS scores were significantly lower in all four groups at T,,T2 and T3 in resting and active states(P＜0.05),and at T2 and T3 were significantly lower than those in the Dxm group(P＜0.05).Conclusion Dexmedetomidine combined with dexamethasone in posterior approach lumbar disc fusion is beneficial in reducing the postoperative inflammatory response of patients,alleviating acute postoperative pain.
基金项目
宁夏回族自治区重点研发计划(2021BEG03048)
NETL
NSTL
万方数据