右美托咪定对经尿道输尿管镜钬激光碎石术中内脏痛的镇痛作用研究
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摘要
目的:探讨右美托咪定对硬膜外麻醉下经尿道输尿管镜钬激光碎石术中内脏痛的影响。方法:选择需行经尿道输尿管镜钬激光碎石治疗输尿管中下段结石的患者60例,随机均分为右美托咪定组(D组)和对照组(C组),两组均采用相同方式进行硬膜外麻醉;D组患者待麻醉稳定后按1μg/kg剂量持续泵注右美托咪定5～10 min使患者进入浅睡眠状态后,给予0.5μg/(kg·h)速率泵注至术毕;C组在相同时点持续泵注等容量生理盐水;分别于围术期各时点(T0～T6时点)采用视觉模拟评分法(VAS)评估患者围手术期疼痛程度,T0～T4时点采用Ramsay镇静评分评估患者术中的镇静情况,T5、T6时点采用舒适量表(BCS)评估术后患者的舒适度;采用ELISA法测定术前30 min、T4及T6时点患者血清去甲肾上腺素(NE)、肾上腺素(N)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)和白细胞介素-6(IL-6)的表达,并观察两组患者围手术期不良反应。结果:除了T0、T6时点外,其余时点两组患者VAS评分C组明显高于D组(P<0.05);除T0时点外,其余时点两组患者Ramsay评分C组评分均明显低于D组(P<0.05);D组T5时点BCS评分显著高于C组(P<0.01);在T4和T6时点,C组患者血清NE、N、CRP以及IL-6水平明显高于D组(P<0.05);两组围手术期不良事件总发生率比较,差异无统计学意义(χ~2=0.218,P>0.05)。结论:右美托咪定能减轻硬膜外麻醉下输尿管镜钬激光碎石术中患者的内脏疼痛,可能与其降低NE、N、IL-6、TNF-α和CRP的水平有关。
Objective: To evaluate the effects of dexmetomidine on visceral pain during transurethral ureteroscopic holmium laser lithotripsy under epidural anesthesia.Methods: A total of 60 patients who underwent transurethral ureteral bypass laser lithotripsy for the treatment of mid-lower ureteral calculi were selected and randomly divided into Dex group(D group, n=30) and control group(C group, n=30). Both groups were applied the same epidural method. After the anesthesia was stable, patients in Group D received sustainable pumping of dexmedetomidine 1 μg/kg for 5 to 10 minutes, which allowed the patients enter a state of shallow sleep, following by 0.5 μg·kg~(-1)·h~(-1) pumping until surgery. In group C, the same volume of physiological saline was continuously pumped at the same time. VAS was used to evaluate the degree of pain in perioperative period(T0～T6 time point). At the time points from T0 to T4. Ramsay sedation score was used to evaluate the sedation of patients during the operation. At the time of T5 and T6, BCS was used to evaluate the comfort of patients after operation. ELISA was used to measure the serum levels of norepinephrine(NE),adrenalin(N), tumor necrosis factor-α(TNFα) C-reactive protein(CRP) and interleukin-6(IL-6) of patients 30 minutes before operation and at time points of T4 and T6. The peri-operative adverse reactions of the two groups were observed. Results: There was no significant difference in VAS score between the two groups at T0 and T6 time points; the VAS pain score of group C was significantly higher than that of group D at the other time points(P<0.05). There was no significant difference in Ramsay score between the two groups at T0 time point, but the scores in group C were significantly lower than those in group D at the other time points(P<0.05). The BCS scores at T5 time point in group D were significantly higher than those in group C(P<0.01). At T4 and T6 time point, levels of NE, N, CRP and IL-6 of group C were significantly higher than those of group D(P<0.05). There was no significant difference in the total incidence of adverse events between the two groups(χ~2=0.218,P>0.05). Conclusion: Dexmetomidine can alleviate visceral pain in ureteroscopic holmium laser lithotripsy under epidural anesthesia, which may be related to its function of decreasing levels of NE, N, IL-6, TNF-αand CRP.
Objective: To evaluate the effects of dexmetomidine on visceral pain during transurethral ureteroscopic holmium laser lithotripsy under epidural anesthesia.Methods: A total of 60 patients who underwent transurethral ureteral bypass laser lithotripsy for the treatment of mid-lower ureteral calculi were selected and randomly divided into Dex group(D group, n=30) and control group(C group, n=30). Both groups were applied the same epidural method. After the anesthesia was stable, patients in Group D received sustainable pumping of dexmedetomidine 1 μg/kg for 5 to 10 minutes, which allowed the patients enter a state of shallow sleep, following by 0.5 μg·kg~(-1)·h~(-1) pumping until surgery. In group C, the same volume of physiological saline was continuously pumped at the same time. VAS was used to evaluate the degree of pain in perioperative period(T0～T6 time point). At the time points from T0 to T4. Ramsay sedation score was used to evaluate the sedation of patients during the operation. At the time of T5 and T6, BCS was used to evaluate the comfort of patients after operation. ELISA was used to measure the serum levels of norepinephrine(NE),adrenalin(N), tumor necrosis factor-α(TNFα) C-reactive protein(CRP) and interleukin-6(IL-6) of patients 30 minutes before operation and at time points of T4 and T6. The peri-operative adverse reactions of the two groups were observed. Results: There was no significant difference in VAS score between the two groups at T0 and T6 time points; the VAS pain score of group C was significantly higher than that of group D at the other time points(P<0.05). There was no significant difference in Ramsay score between the two groups at T0 time point, but the scores in group C were significantly lower than those in group D at the other time points(P<0.05). The BCS scores at T5 time point in group D were significantly higher than those in group C(P<0.01). At T4 and T6 time point, levels of NE, N, CRP and IL-6 of group C were significantly higher than those of group D(P<0.05). There was no significant difference in the total incidence of adverse events between the two groups(χ~2=0.218,P>0.05). Conclusion: Dexmetomidine can alleviate visceral pain in ureteroscopic holmium laser lithotripsy under epidural anesthesia, which may be related to its function of decreasing levels of NE, N, IL-6, TNF-αand CRP.
引文
[1] ALDOUKHI A H,ROBERTS W W,HALL T L,et al.Holmium laser lithotripsy in the new stone age:Dust or bust[J].Front Surg,2017,9(4):57.
[2] MEERVELD B G,JOHNSON A C.Mechanisms of stress-induced visceral pain[J].J Neurogastroenterol Motil,2018 ,24(1):7-18.
[3] SNOW T,ANWAR S.The power of perioperative dexmedetomidine[J].J Cardiothorac Vasc Anesth,2018,32(1):e33-e34.
[4] TüRK C,PET,et al.EAU guidelines on diagnosis and conservative management of urolithiasis[J].Eur Urol,2016,69(3):468-474.
[5] 那彦群,叶章群,孙光.中国泌尿外科疾病诊断治疗指南(2009年版)[M].北京:人民卫生出版社,2009:116.
[6] YOSHIOKA T,OTSUKI H,UEHARA S,et al.Effectiveness and safety of ureteroscopic holmium laser lithotripsy for upper urinary tract calculi in elderly patients[J].Acta Med Okayama,2016,70(3):159-166.
[7] BHANA N,GOA K L,MCCLELLAN K J.Dexmedetomindine[J].Drugs,2000,59(2):263-268.
[8] COULL J T,JONES M,EGAN T,et al.Attentional effects of noradrenaline vary with arousal level:Selective activation of thalamic pulvinar in humans[J].Neuroimage,2004,22(1):315-322.
[9] XU B,ZHANG W S,YANG J L,et al.Dexmedetomidine blocks thermal hyperalgesia and spinal glial activation in rat model of monoarthritis[J].Acta Pharmacologica Sin,2010,31(5):523-530.
[10]张文娟,方开云不同剂量右美托咪定对神经外科手术患者全身麻醉恢复质量的影响[J].贵阳医学院学报,2016,41(1):99-102
[11]CHROUSOS G P,GOLD P W.The concepts of stress and stress system disorders.Overview of physical and behavioral homeostasis [J].JAMA,1992,267(9):1244-1252
[12]MANINI P,PANZELLA L,TEDESCO I,et al.Tetrahydrobiisoquinoline derivatives by reaction of dopamine with glyoxal:a novel potential degenerative pathway of catecholamines under oxidative stress conditions[J].Chem Res Toxicol,2004,17(9):1190-1198.
[13]YOUNG EA,BRESLAU N.Cortisol and catecholamines in posttraumatic stress disorder:An epidemiologic community study[J].Arch Gen Psychiatry,2004,61(4):394-401.
[14]MRAVEC B,KISS A.The brain catecholamines:Brief anatomy and participation in the stress reaction and regulation of cardiovascular function][J].Cesk Fysiol,2004,53(3):102-116.
[15]REIMS HM,SEVRE K,FOSSUM E,et al.Plasma catecholamines,blood pressure responses and perceived stress during mental arithmetic stress in young men[J].Blood Press,2004,13(5):287-294.
[16]CASTRO P,PéREZ O,GREIG D,DíAZ-ARAYA G,et al.Effects of carvedilol on functional capacity,left ventricular function,catecholamines and oxidative stress in patients with chronic heart failure][J].Rev Esp Cardiol,2004 ,57(11):1053-1058.
[17]SOMMER C,LEINDERS M,ü?EYLER N.Inflammation in the pathophysiology of neuropathic pain[J].Pain,2018,159(3):595-602.
[18]ZHOU H,LU J,SHEN Y,et al.Effects of dexmedetomidine on CD42a+/CD14+,HLADR+/CD14+ and inflammatory cytokine levels in patients undergoing multilevel spinal fusion[J].Clin Neurol Neurosurg,2017,160:54-58.
[19]MAGNI G,RICCIO D,CERUTI S.Tackling chronic pain and inflammation through the purinergic system[J].Curr Med Chem,2018,25(32):3830-3865.
[20]刘德昭,黄品婕,罗晨芳,等.脂微球化前列地尔对原位肝移植术患者肺损伤的影响[J].中华麻醉学杂志,2013,33(3):338.
[21]MONTAUDIé H,SETITZ-POLSKI B,CORNILLE A,et al.Interleukin 6 and high-sensitivity C-reactive protein are potential predictive markers of responseto infliximab in hidradenitis suppurativa [J].J Am Acad Dermatol,2017,76(1):156-158
[22]FRANCHI S,SACERDOTE P,PANERAI A.The prokineticin system:an interface between neural inflammation and pain[J].Neurol Sci,2017,38(Suppl 1):27-30.
[23]VASIC V,SCHMIDT MHH.Resilience and vulnerability to pain and inflammation in the hippocampus[J].Int J Mol Sci,2017,18(4):E739.
[2] MEERVELD B G,JOHNSON A C.Mechanisms of stress-induced visceral pain[J].J Neurogastroenterol Motil,2018 ,24(1):7-18.
[3] SNOW T,ANWAR S.The power of perioperative dexmedetomidine[J].J Cardiothorac Vasc Anesth,2018,32(1):e33-e34.
[4] TüRK C,PET,et al.EAU guidelines on diagnosis and conservative management of urolithiasis[J].Eur Urol,2016,69(3):468-474.
[5] 那彦群,叶章群,孙光.中国泌尿外科疾病诊断治疗指南(2009年版)[M].北京:人民卫生出版社,2009:116.
[6] YOSHIOKA T,OTSUKI H,UEHARA S,et al.Effectiveness and safety of ureteroscopic holmium laser lithotripsy for upper urinary tract calculi in elderly patients[J].Acta Med Okayama,2016,70(3):159-166.
[7] BHANA N,GOA K L,MCCLELLAN K J.Dexmedetomindine[J].Drugs,2000,59(2):263-268.
[8] COULL J T,JONES M,EGAN T,et al.Attentional effects of noradrenaline vary with arousal level:Selective activation of thalamic pulvinar in humans[J].Neuroimage,2004,22(1):315-322.
[9] XU B,ZHANG W S,YANG J L,et al.Dexmedetomidine blocks thermal hyperalgesia and spinal glial activation in rat model of monoarthritis[J].Acta Pharmacologica Sin,2010,31(5):523-530.
[10]张文娟,方开云不同剂量右美托咪定对神经外科手术患者全身麻醉恢复质量的影响[J].贵阳医学院学报,2016,41(1):99-102
[11]CHROUSOS G P,GOLD P W.The concepts of stress and stress system disorders.Overview of physical and behavioral homeostasis [J].JAMA,1992,267(9):1244-1252
[12]MANINI P,PANZELLA L,TEDESCO I,et al.Tetrahydrobiisoquinoline derivatives by reaction of dopamine with glyoxal:a novel potential degenerative pathway of catecholamines under oxidative stress conditions[J].Chem Res Toxicol,2004,17(9):1190-1198.
[13]YOUNG EA,BRESLAU N.Cortisol and catecholamines in posttraumatic stress disorder:An epidemiologic community study[J].Arch Gen Psychiatry,2004,61(4):394-401.
[14]MRAVEC B,KISS A.The brain catecholamines:Brief anatomy and participation in the stress reaction and regulation of cardiovascular function][J].Cesk Fysiol,2004,53(3):102-116.
[15]REIMS HM,SEVRE K,FOSSUM E,et al.Plasma catecholamines,blood pressure responses and perceived stress during mental arithmetic stress in young men[J].Blood Press,2004,13(5):287-294.
[16]CASTRO P,PéREZ O,GREIG D,DíAZ-ARAYA G,et al.Effects of carvedilol on functional capacity,left ventricular function,catecholamines and oxidative stress in patients with chronic heart failure][J].Rev Esp Cardiol,2004 ,57(11):1053-1058.
[17]SOMMER C,LEINDERS M,ü?EYLER N.Inflammation in the pathophysiology of neuropathic pain[J].Pain,2018,159(3):595-602.
[18]ZHOU H,LU J,SHEN Y,et al.Effects of dexmedetomidine on CD42a+/CD14+,HLADR+/CD14+ and inflammatory cytokine levels in patients undergoing multilevel spinal fusion[J].Clin Neurol Neurosurg,2017,160:54-58.
[19]MAGNI G,RICCIO D,CERUTI S.Tackling chronic pain and inflammation through the purinergic system[J].Curr Med Chem,2018,25(32):3830-3865.
[20]刘德昭,黄品婕,罗晨芳,等.脂微球化前列地尔对原位肝移植术患者肺损伤的影响[J].中华麻醉学杂志,2013,33(3):338.
[21]MONTAUDIé H,SETITZ-POLSKI B,CORNILLE A,et al.Interleukin 6 and high-sensitivity C-reactive protein are potential predictive markers of responseto infliximab in hidradenitis suppurativa [J].J Am Acad Dermatol,2017,76(1):156-158
[22]FRANCHI S,SACERDOTE P,PANERAI A.The prokineticin system:an interface between neural inflammation and pain[J].Neurol Sci,2017,38(Suppl 1):27-30.
[23]VASIC V,SCHMIDT MHH.Resilience and vulnerability to pain and inflammation in the hippocampus[J].Int J Mol Sci,2017,18(4):E739.