盐酸氢吗啡酮术后镇痛对老年髋关节置换术患者炎性因子及 S-100β、NSE 的影响

摘要

[ABSTRACT]Objective:To explore the effect of hydromorphone hydrochloride postoperative analgesia on the inflammato-ry cytokines,S-100β,and NSE in elderly patients after total hip replacement (THR).Methods:A total of 100 patients who were admitted in our hospital from January,201 5 to July,201 6 for THR were included in the study and randomized into the observation group and the control group with 50 cases in each group.After operation,the patients in the two groups were im-mediately given patient-controlled analgesia.The patients in the observation group were given hydromorphone hydrochloride (0.3 mg)+ dexamethasone (5 mg)+ normal saline (100 mL),while the patients in the control group were given sufentanil (1 50 μg)+ dexamethasone (5 mg)+ normal saline (100 mL).The morning fasting peripheral venous blood before operation, 24 h and 3 d after operation in the two groups was collected.ELISA was used to detect the serum CRP,IL-6,and TNF-α,and the plasma S-100βand NSE levels.Results:The serum CRP,TNF-α,and IL-6 levels 24 h and 3 d after operation in the two groups were significantly elevated when compared with before operation (P <0.05),and were reduced 3d after operation.CRP, TNF-α,and IL-6 levels at each timing point after operation in the observation group were significantly lower than those in the control group (P <0.05).The plasma S-100βand NSE levels 24 h and 3 d after operation in the two groups were significantly elevated when compared with before operation (P <0.05),and were reduced 3d after operation.The plasma S-100βand NSE levels at each timing point after operation in the observation group were significantly lower than those in the control group (P<0.05).Conclusions:Hydromorphone hydrochloride can relieve the postoperative pain in elderly patients with THR,effective-ly alleviate the inflammatory reaction,reduce the plasma S-100βand NSE levels,and alleviate the cerebral injury,whose path-ogenesis remains a further deep study.%目的：：探讨盐酸氢吗啡酮术后镇痛对老年髋关节置换术(THR)患者炎性因子及 S-100β蛋白(S-100β)、神经元特异性烯醇化酶(NSE)的影响.方法：选取2015年1月~2016年7月于我院实施 THR患者100例为研究对象,随机分为观察组和对照组,各50例,两组均于手术结束后立即连接自控镇痛泵,观察组用药为盐酸氢吗啡酮0．3 mg＋地塞米松5 mg＋生理盐水100 mL,对照组为舒芬太尼150μg＋地塞米松5 mg＋生理盐水100 mL.两组于术前、术后24 h、术后3 d 采集清晨空腹外周静脉血,测定血清 C 反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)及血浆 S-100β、NSE 水平.结果：两组术后24 h、术后3 d 血清 CRP、TNF-α、IL-6水平明显高于术前,于术后3 d 有所降低,且观察组术后各时间点 CRP、TNF-α、IL-6水平低于对照组；两组术后24 h、术后3 d 血浆 S-100β、NSE 水平明显高于术前,于术后3 d 有所降低,且观察组术后各时间点血浆 S-100β、NSE 水平低于对照组.结论：盐酸氢吗啡酮可缓解老年 THR 患者的术后疼痛,有效减轻炎症反应,降低血浆 S-100β、NSE 水平,具有减轻脑损伤的作用,其机制有待进一步深入探讨.