右美托咪定复合曲马多超前镇痛对骨关节置换术患者镇痛效果、血流动力学及认知功能的影响

目的:探讨右美托咪定复合曲马多超前镇痛对骨关节置换术患者镇痛效果、血流动力学及认知功能的影响。方法:选取2015年2月~2018年12月期间武警陕西省总队医院收治的行骨关节置换术患者121例,根据数表法将患者随机分为对照组(n=60)和研究组(n=61),其中对照组给予曲马多超前镇痛,研究组在对照组的基础上联合右美托咪定,比较两组患者镇痛效果、血流动力学指标及认知功能,记录两组手术期间不良反应发生情况。结果:研究组术后4 h(T2)、术后8 h(T3)、术后12 h(T4)、术后24 h(T5)时间点视觉模拟评分(VAS)低于对照组(P<0.05)。研究组T2~T5时间点心率(HR)、平均动脉压(MAP)低于对照组,血氧饱和度(SPO2)则高于对照组(P<0.05)。研究组术后3 d、术后1周简易精神状态量表(MMSE)评分较对照组升高,中枢神经特异蛋白(S100β)水平则低于对照组(P<0.05)。两组不良反应总发生率比较无差异(P>0.05)。结论:骨关节置换术患者给予右美托咪定复合曲马多超前镇痛,镇痛效果确切,可有效维持血流动力学稳定,且对机体认知功能影响较轻,不增加不良反应发生率,临床应用价值较高。

Effect of of Preemptive Analgesia with Dexmedetomidine and Tramadol on Pain Relief, Hemodynamics and Cognitive Function in Osteoarthroplasty Patients

Objective: To investigate the effect of preemptive analgesia with dexmedetomidine and tramadol on pain relief, hemodynamics and cognitive function in osteoarthroplasty patients. Methods: 121 cases of osteoarthroplasty in Shaanxi Provincial Armed Police Corps Hospital from February 2015 to December 2018 were selected, which were randomly divided into control group(n=60) and research group(n=61) according to the number table method. The control group was given tramadol for preemptive analgesia, and the research group was combined with dexmedetomidine on the basis of the control group. The analgesic effect, hemodynamics and cognitive function of the two groups were compared, the occurrence of adverse reactions in two groups during operation were recorded. Results:Visual Analogue Scale(VAS) scores at 4 h(T2), 8 h(T3), 12 h(T4) and 24 h(T5) time point after operation in the study group were lower than that in the control group(P<0.05). Heart rate(HR) was lower in the study group than that in the control group at T2-T5 time point, while blood oxygen saturation(SPO2) in the study group was lower than that in the control group, and mean arterial pressure(MAP)was higher than that in the control group(P<0.05). Simple Mental State Scale(MMSE) scores in the study group were higher than those in the control group at 3 d after operation and 1 week after operation, while central nervous specific protein(S100β) scores were lower than those in the control group(P<0.05). There was no difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion: Preemptive analgesia with dexmedetomidine combined with tramadol has definite analgesic effect in osteoarthroplasty patients, which can effectively maintain hemodynamic stability with little effect on cognitive function, and does not increase the incidence of adverse reactions. It has high clinical application value.