酮咯酸氨丁三醇在老年人全髋关节置换术术后的作用  

Effect of ketorolac tromethamine on elderly patients after receiving total hip arthroplasty

作　　者：王英萍[1] 李俊凯[2] 郭宝磊[1] 王臣[3] WANG Ying-ping;LI Jun-kai;GUO Bao-lei;WANG Chen(Department of Osteology,Shenyang Osteological Hospital,Shenyang 110024,China;Department of Anesthesiology,Shenyang Osteological Hospital,Shenyang 110024,China;Department of Osteology,Shenyang 4th Hospital,Shenyang 110001,China)

机构地区：[1]沈阳市骨科医院骨科,辽宁沈阳110024 [2]沈阳市骨科医院麻醉科,辽宁沈阳110024 [3]沈阳市第四人民医院骨科,辽宁沈阳110001

出　　处：《实用药物与临床》2020年第12期1095-1098,共4页Practical Pharmacy and Clinical Remedies

基　　金：辽宁省自然基金课题(2019-MS-294)。

摘　　要：目的评价酮咯酸氨丁三醇在老年人全髋关节置换手术术后镇痛中的应用价值及对体液免疫及细胞免疫的影响。方法随机选取2015年2月至2019年5月我院收治的连续硬膜外麻醉行全髋关节置换术的老年患者62例,以计算机随机数法分为观察组及对照组,每组31例,观察组术后给予酮咯酸氨丁三醇90 mg+舒芬太尼150μg+雷莫司琼300 mg进行患者自控镇痛,对照组给予舒芬太尼150μg+雷莫司琼300 mg进行自控镇痛,比较术后不同时点患者NRS评分,术后关节功能恢复时间,髋关节功能Harris评分及生活质量SF-36评分。以全自动生化仪及流式细胞术检测术后体液免疫及细胞免疫变化。结果术后不同时点NRS评分观察组均低于对照组,观察组与对照组在术后16 h、20 h、36 h、48 h、60 h、72 h的NRS评分差异有统计学意义(P<0.05)。麻醉消除后,观察组髋关节外展45°时间及直腿抬高30°短于对照组(P<0.01),Harris评分高于对照组(P<0.05),近期生活质量SF-36评分高于对照组(P<0.05)。与术前比较,术后24 h、48 h、72 h两组体液免疫指标(IgM、IgA、IgG)及细胞免疫指标(CD3^+、CD4^+/CD8^+)比较差异有统计学意义(P<0.05);术后48 h,观察组IgM、CD3^+、CD4^+/CD8^+高于对照组(P<0.05);术后72 h,观察组IgM、IgA、CD3^+、CD4^+/CD8^+高于对照组(P<0.05)。结论酮咯酸氨丁三醇在老年人全髋关节置换术术后应用可提高镇痛效果,促进患者免疫功能恢复。Objective To evaluate the application value of ketorolac tromethamine in post-operative analgesia and its effect on body fluid and cellular immune function in elderly patients after receiving total hip arthroplasty.Methods Sixty-two elderly patients who underwent total hip arthroplasty under continuous epidural anesthesia from February 2015 to May 2019 were selected randomly and divided into experimental group and control group,31 cases in each group.Ketorolac tromethamine(90 mg)+sufentanil(150μg)+ramosetron(300 mg)was given after operation in experimental group,and sufentanil(150μg)+ramosetron(300 mg)was given in control group for patient-controlled intravenous analgesia.Post-operative NRS,joint recovery time,Harris score and SF-36 scores were compared at different time points.Body fluid and cellular immune function was detected by automatic biochemical instrument and flow cytometry assay.Results NRS in experimental group was all lower than that in control group,and there was difference at 16 h,20 h,36 h,48 h,60 h and 72 h after operation(P<0.05).The time of hip joint abduction 45° and straight-leg raising 30° after anesthesia was eliminated was shorter in experiment group than in control group(P<0.01).Harris score and SF-36 score of experimental group were higher than those of control group(P<0.05).Compared with before operation,there were significant differences in the levels of IgM,IgA,IgG,CD3^+ and CD4^+/CD8^+ between the two groups at 24 h,48 h and 72 h after operation(P<0.05).The levels of IgM,CD3^+ and CD4^+/CD8^+ in experimental group were higher than those in control group at 48h after operation(P<0.05);the levels of IgM,IgA,CD3^+ and CD4^+/CD8^+ in experimental group were higher than those in control group at 72 h after operation(P<0.05).Conclusion Ketorolac tromethamine can improve post-operation analgesia effect in total hip joint arthroplasty in elderly patients and promote the recovery of immune function.

关 键 词：酮咯酸氨丁三醇 NRS评分 全髋关节置换术 

分 类 号：R614[医药卫生—麻醉学]