摘要
目的:观察右美托咪定联合超声引导神经阻滞对髋部骨折合并糖尿病患者术后镇痛效果、免疫应激和疼痛介质的影响.方法:按照随机数字表法将2020年6月-2023年6月期间我院收治的120例髋部骨折合并糖尿病患者分为对照组60例(超声引导神经阻滞)和研究组60例(右美托咪定联合超声引导神经阻滞).术后两组均行自控静脉镇痛(PCIA)镇痛.对比两组镇静、镇痛情况、PCIA按压次数、免疫功能、应激反应、疼痛介质,同时观察两组治疗期间不良反应发生情况.结果:术后12h、术后24h、术后48 h,研究组视觉模拟评分法(VAS)评分低于对照组,Ramsay镇静评分高于对照组(P＜0.05).研究组的PCIA按压次数少于对照组(P＜0.05).术后1d,研究组CD3+、CD4+、CD4+/CD8+高于对照组,皮质醇(Cor)、甲肾上腺素(NE)、前列腺素E2(PGE2)、肾上腺素(E)、降钙素基因相关肽(CGRP)、P物质(SP)、CD8+低于对照组(P＜0.05).不良反应发生率方面,两组组间对比未见差异(P＞0.05).结论:联合应用超声引导神经阻滞和右美托咪定于髋部骨折合并糖尿病患者,可发挥良好的镇静、镇痛效果,减轻免疫抑制和术后疼痛.
Abstract
Objective:To observe the effects of dexmedetomidine combined with ultrasound-guided nerve block on postoperative analgesia,immune stress and pain mediators in patients with hip fracture complicated with diabetes.Methods:120 patients with hip frac-ture complicated with diabetes who were admitted to our hospital from June 2020 to June 2023 were divided into control group 60 cases(ultrasound-guided nerve block)and study group 60 cases(dexmedetomidine combined with ultrasound-guided nerve block)according to the random number table method.Postoperative patient-controlled intravenous analgesia(PCIA)was performed in both groups.The se-dation,analgesia,PCIA pressing times,immune function,stress response and pain mediators were compared between two groups,and the occurrence of adverse reactions during the treatment was observed.Results:12 h,24 h and 48 h after operation,the visual analogue scale(VAS)score in study group was lower than that in control group,and the Ramsay sedation score was higher than that in control group(P＜0.05).The number of PCIA compressions in study group was less than that in control group(P＜0.05).1 d after operation,CD3+,CD4+,CD4+/CD8+in study group were higher than those in control group,and cortisol(Cor),norepinephrine(NE),prostaglandin E2(PGE2),epinephrine(E),calcitonin gene-related peptide(CGRP),substance P(SP)and CD8+were lower than those in control group(P＜0.05).In terms of incidence of adverse reactions,there was no difference observed between the two groups in comparison(P＞0.05).Conclusion:Ultrasound-guided nerve block combined with dexmedetomidine in patients with hip fracture and diabetes,which can exert good sedative and analgesic effects,reduce immunosuppression and postoperative pain.
基金项目
安徽省自然科学基金项目(20210319)
合肥市第二人民医院院级科研基金项目(2021 ygkt39)
合肥市卫健委应用医学研究项目(Hwk2021vb009)
NETL
NSTL
万方数据