中华老年多器官疾病杂志
中華老年多器官疾病雜誌
중화노년다기관질병잡지
CHINESE JOURNAL OF MULTIPLE ORGAN DISEASES IN THE ELDERLY
2013年
11期
806-809
,共4页
张凌云%刘叶荣%谭萍%薛建军%何炎鸿%李岩
張凌雲%劉葉榮%譚萍%薛建軍%何炎鴻%李巖
장릉운%류협영%담평%설건군%하염홍%리암
氯胺酮%经静脉患者自控镇痛%全髋关节置换术%肿瘤坏死因子-α%白细胞介素-1β
氯胺酮%經靜脈患者自控鎮痛%全髖關節置換術%腫瘤壞死因子-α%白細胞介素-1β
록알동%경정맥환자자공진통%전관관절치환술%종류배사인자-α%백세포개소-1β
ketamine%patient controlled intravenous analgesia%total hip replacement%tumor necrosis factor-α%interleukin-1β
目的：观察小剂量氯胺酮＋芬太尼用于全髋关节置换术患者术后镇静、镇痛的效果，以及对细胞因子肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）的表达的影响。方法80例全髋关节置换术后患者随机分为两组行术后经静脉患者自控镇痛（PCIA），F组（40例）配方芬太尼20μg/kg＋昂丹司琼8mg＋生理盐水至100ml；FK组（40例）芬太尼16μg/kg＋氯胺酮2mg/kg＋昂丹司琼8mg＋生理盐水至100ml。术后静脉持续泵注2ml/h，观察不同时间点视觉模拟评分（VAS）镇痛、镇静、呼吸血压变化、恶心呕吐等不良反应，血清TNF-α和IL-1β的表达。结果两组患者术后各时间点VAS镇痛、镇静评分、平均动脉压、血氧饱和度比较差异无统计学意义（P＞0.05）；KF组患者与F组比较，术后恶心、呕吐不良反应明显减少（P＜0.05）；术后0及4h IL-1β的表达差异无统计学意义（P＞0.05），术后12及24h IL-1β表达明显降低（P＜0.05）；术后各时间点TNF-α的表达差异无统计学意义（P＞0.05）。结论小剂量氯胺酮复合芬太尼用于髋关节置换术患者术后镇痛，较传统的单用芬太尼术后静脉镇痛，能产生良好的镇痛效果，减少恶心、呕吐等不良反应，同时能抑制炎症因子IL-1β的表达，更有利于患者的康复。
目的：觀察小劑量氯胺酮＋芬太尼用于全髖關節置換術患者術後鎮靜、鎮痛的效果，以及對細胞因子腫瘤壞死因子-α（TNF-α）、白細胞介素-1β（IL-1β）的錶達的影響。方法80例全髖關節置換術後患者隨機分為兩組行術後經靜脈患者自控鎮痛（PCIA），F組（40例）配方芬太尼20μg/kg＋昂丹司瓊8mg＋生理鹽水至100ml；FK組（40例）芬太尼16μg/kg＋氯胺酮2mg/kg＋昂丹司瓊8mg＋生理鹽水至100ml。術後靜脈持續泵註2ml/h，觀察不同時間點視覺模擬評分（VAS）鎮痛、鎮靜、呼吸血壓變化、噁心嘔吐等不良反應，血清TNF-α和IL-1β的錶達。結果兩組患者術後各時間點VAS鎮痛、鎮靜評分、平均動脈壓、血氧飽和度比較差異無統計學意義（P＞0.05）；KF組患者與F組比較，術後噁心、嘔吐不良反應明顯減少（P＜0.05）；術後0及4h IL-1β的錶達差異無統計學意義（P＞0.05），術後12及24h IL-1β錶達明顯降低（P＜0.05）；術後各時間點TNF-α的錶達差異無統計學意義（P＞0.05）。結論小劑量氯胺酮複閤芬太尼用于髖關節置換術患者術後鎮痛，較傳統的單用芬太尼術後靜脈鎮痛，能產生良好的鎮痛效果，減少噁心、嘔吐等不良反應，同時能抑製炎癥因子IL-1β的錶達，更有利于患者的康複。
목적：관찰소제량록알동＋분태니용우전관관절치환술환자술후진정、진통적효과，이급대세포인자종류배사인자-α（TNF-α）、백세포개소-1β（IL-1β）적표체적영향。방법80례전관관절치환술후환자수궤분위량조행술후경정맥환자자공진통（PCIA），F조（40례）배방분태니20μg/kg＋앙단사경8mg＋생리염수지100ml；FK조（40례）분태니16μg/kg＋록알동2mg/kg＋앙단사경8mg＋생리염수지100ml。술후정맥지속빙주2ml/h，관찰불동시간점시각모의평분（VAS）진통、진정、호흡혈압변화、악심구토등불량반응，혈청TNF-α화IL-1β적표체。결과량조환자술후각시간점VAS진통、진정평분、평균동맥압、혈양포화도비교차이무통계학의의（P＞0.05）；KF조환자여F조비교，술후악심、구토불량반응명현감소（P＜0.05）；술후0급4h IL-1β적표체차이무통계학의의（P＞0.05），술후12급24h IL-1β표체명현강저（P＜0.05）；술후각시간점TNF-α적표체차이무통계학의의（P＞0.05）。결론소제량록알동복합분태니용우관관절치환술환자술후진통，교전통적단용분태니술후정맥진통，능산생량호적진통효과，감소악심、구토등불량반응，동시능억제염증인자IL-1β적표체，경유리우환자적강복。
Objective To investigate the analgesic effect of small dose ketamine, and its impact on the expression of plasma tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in patients after total hip replacement. Methods A total of 80 patients (with age of 65 to 80 and ASA grade Ⅰ to Ⅲ) after total hip replacement underwent patient controlled intravenous analgesia (PCIA) in our department. They were randomly divided into two groups: fentanyl and ondansetron group (F group, 20μg/kg fentanyl+8mg ondansetron+normal saline till 100ml, n=40), and small dose ketamine combined with fentanyl and ondansetron group (KF group, 16μg/kg fentanyl+2mg/kg ketamine+8mg ondansetron+normal saline till 100ml, n=40) at a continuous intravenous infusion of 2ml/h. Visual analogue scale (VAS), mean aterial pressure (MAP), blood oxygen saturation (SpO2), side-effects during PCIA (such as nausea and vomiting), and the plasma levels of TNF-α and IL-1β were recorded and compared between the two groups at different time points. Results There was no significant difference in the VAS, sedation score, MAP and SpO2 between the two groups at all time points (P>0.05), but the incidence of side-effects was significantly lower in KF group than in F group (P<0.05). No significant difference was found in the plasma level of IL-1β between the two groups in 0 and 4h after operation; but in 12 and 24h after operation, that in KF group was significantly lower (P<0.05). No significant difference was found in the level of TNF-αbetween the two groups at all time points. (P>0.05). Conclusion Small dose ketamine combined with fentanyl in PCIA has better analgesic effect than conventional method of using fentanyl alone for patients after total hip replacement. It also reduces the incidence of nausea and vomiting and inhibits the expression of inflammatory factor IL-1β, and thus is helpful to patient’s recovery.
