摘要
目的研究右美托咪定复合罗哌卡因髂筋膜间隙阻滞用于老年髋关节置换术的镇痛效果及对磷脂酰肌醇3激酶(PI3K)-蛋白激酶B(Akt)信号通路的影响。方法前瞻性选取2020年5月至2022年5月于南通市海门区人民医院接受髋关节置换术治疗的患者100例,按随机数字表法将其分为观察组和对照组,每组各50例。两组患者均行髋关节置换术,对照组患者行罗哌卡因髂筋膜间隙阻滞,观察组患者行右美托咪定复合罗哌卡因髂筋膜间隙阻滞。比较两组围手术期指标、血流动力学(心率、舒张压、收缩压)、镇痛效果[视觉模拟评分法(VAS)评分、Ramsay镇静评分]、认知功能[简易智能精神状态检查(MMSE)量表]、PI3K-Akt信号通路标志性蛋白(PI3K、Akt)表达水平及不良反应发生情况。结果两组手术时间、麻醉时间比较,差异均无统计学意义(P>0.05),观察组术中出血量、输液量均低于较对照组,差异均有统计学意义(P<0.05)。观察组麻醉诱导后5 min、插管、拔管时心率、收缩压、舒张压均低于对照组,差异均有统计学意义(P<0.05)。术后2、6、12 h,观察组的VAS评分分别为(1.23±0.17)、(3.02±0.43)、(3.16±0.44)分,均低于对照组[(1.43±0.20)、(3.47±0.48)、(3.61±0.51)分],Ramsay镇静评分分别为(2.17±0.31)、(2.96±0.42)、(3.49±0.49)分,均高于对照组[(1.83±0.26)、(2.14±0.30)、(2.91±0.41)分],差异均有统计学意义(P<0.05)。术后1、3、7 d,观察组认知功能评分分别为(27.58±3.94)、(28.63±4.09)、(29.16±4.15)分,均高于对照组[(24.13±3.30)、(24.70±3.37)、(25.05±3.61)分],差异均有统计学意义(P<0.05)。术后6、12 h,观察组PI3K蛋白表达水平分别为0.90±0.13、0.79±0.11,Akt蛋白表达水平分别为1.09±0.15、1.10±0.15,均高于对照组(0.73±0.10、0.65±0.09和0.91±0.13、0.94±0.14),差异均有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论右美托咪定复合罗哌卡因髂筋膜间隙阻滞用于老年髋关节置换术具有出血量、输液量较少的优势,同时能使术中血流动力学维持稳定,降低术后疼痛,对PI3K-Akt信号通路有一定调节作用。
Objective To study the analgesic effect of dexmedetomidine combined with ropivacaine iliac fascia space block in elderly hip arthroplasty and its effect on phosphatidylinositol 3 kinase(PI3K)-protein kinase B(Akt)signaling pathway.Methods To conduct a prospective study,100 patients who received hip arthroplasty in Haimen District People's Hospital of Nantong City from May 2020 to May 2022 were selected and divided into observation group and control group according to random number table method,with 50 patients in each group.Hip joint replacement was performed in both groups,ropivacaine iliac fascia space block was used in control group,dexmedetomidine combined with Ropivacaine was used in observation group.Perioperative indexes,hemodynamics(heart rate,systolic blood pressure,diastolic blood pressure),analgesic effect[visual analog scale(VAS)score,Ramsay sedation score],the cognitive function[mini-mental state examination(MMSE)scale],the expression levels of PI3K-Akt signal pathway signature protein(PI3K,Akt),adverse reactions.Results There were no statistically significant differences in operation time and anesthesia time between the two groups(P>0.05).The amount of blood loss and infusion in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).The heart rate,systolic blood pressure,and diastolic blood pressure of the observation group were significantly lower than those of the control group at 5 minutes after anesthesia induction,intubation,and extubation,the differences were statistically significant(P<0.05).At 2,6,and 12 hours after surgery,the VAS scores of the observation group were(1.23±0.17),(3.02±0.43),and(3.16±0.44)points,respectively,which were lower than those of the control group[(1.43±0.20),(3.47±0.48),and(3.61±0.51)points],the Ramsay sedation scores were(2.17±0.31),(2.96±0.42),and(3.49±0.49)points,which were higher than those of the control group[(1.83±0.26),(2.14±0.30),and(2.91±0.41)points],the differences were statistically significant(P<0.05).At 1,3,and 7 days after surgery,the cognitive function scores of the observation group were were(27.58±3.94),(28.63±4.09),and(29.16±4.15)points,respectively,which were higher than those of the control group[(24.13±3.30),(24.70±3.37),and(25.05±3.61)points],and the differences were statistically significant(P<0.05).At 6 and 12 hours after surgery,the expression levels of PI3K proteins in the observation group were 0.90±0.13,0.79±0.11,and the expression levels of Akt proteins were 1.09±0.15,1.10±0.15,which were higher than those in the control group(0.73±0.10,0.65±0.09,and 0.91±0.13,0.94±0.14),and the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Dextrmedetomidine combined with Ropivacaine for iliac fascial space block in elderly hip joint replacement has the advantages of less blood loss and infusion volume,while maintaining stable hemodynamics during operation,reducing postoperative pain,and has a certain regulatory effect on PI3K Akt signal pathway.
作者
张倍倍
张爽
陈钱正
刁寒
殷庆堂
ZHANG Bei-bei;ZHANG Shuang;CHEN Qian-zheng(Department of Anesthesiology,Haimen District People's Hospital of Nantong City,Nantong Jiangsu 226100,China)
出处
《临床和实验医学杂志》
2023年第17期1901-1904,F0003,共5页
Journal of Clinical and Experimental Medicine
基金
江苏省卫生厅科技项目(编号:H202013)。
