高乌甲素应用于老年臂丛神经阻滞患者围术期镇痛及其对氧化应激的影响

目的观察高乌甲素超前镇痛在臂丛神经阻滞麻醉的老年患者中的应用效果以及其对术后氧化应激水平的影响。方法 46例老年患者随机分为对照组(Ⅰ组,n=23)和高乌甲素组(Ⅱ组,n=23)。Ⅱ组在麻醉前20min静脉推注高乌甲素4mg后缓慢静滴100ml生理盐水稀释的高乌甲素4mg至手术结束;Ⅰ组予以等量生理盐水。动态监测术中HR、BP、SpO2、RR及VAS评分变化;比较两组术后24h内VAS评分,Ramsay镇静评分,PCA效果及不良反应发生率;生化法检测术后0、1、3、6、12、24h患侧血清中MDA、SOD表达水平。结果Ⅱ组切缝皮及探查时HR、BP、SpO2、RR等变化幅度及VAS评分明显低于Ⅰ组;Ⅱ组术后镇静镇痛评分优于Ⅰ组(P<0.05);PCA按压次数及总药量明显少于Ⅰ组(P<0.05);Ⅱ组术后1～24h的SOD值高于Ⅰ组,而MDA值低于Ⅰ组(P<0.05)。结论运用高乌甲素超前镇痛有助于减轻老年臂丛神经阻滞麻醉患者围术期急性疼痛,完善PCA效果和抑制术后早期氧化应激反应。

Analgesic effect of Lappaconitine and its influence to oxidative stress activity in aged patients with brachial block

Objective To observe the analgesic effects as well as its influence to the level of oxidative stress of Lappaconitine for aged patients with brachial block.Methods 46 cases were randomized into two groups（n=23）.Intravenous injection of 4 mg Lappaconitine as the loading dose 20 mins before the brachial block,then slowly intravenous infusing 4 mg Lappaconitine which was diluted with 100 ml physiological saline until the end of the surgery for patients in group Ⅱ as well as equivalent physiological saline in groupⅠ.Dynamicly monitoring HR、BP、SpO2、RR and VAS changes in perioperative period;Comparing the VAS score,Ramsay score,adverse reactions and the effect of PCA in 24 h after the operation;Measuring the activity of SOD and MDA between the two groups at 0 h,1 h,3 h,6 h,12 h,24 h after the surgery.Results The changes of HR、BP、SpO2、RR and VAS were obviously lower in groupⅡthan groupⅠwhen incising and closuring skin（P0.05）.In 24 h after the surgery,the VAS score and Ramsay score of groupⅡwere lower than patients in groupⅠas well as the total analgesia amounts and PCA frequencies（P0.05）.The activity of SOD dropped while the content of MDA raised in all patients after operation,but the changes amplitude was significantly higher in groupⅠthan groupⅡ（P0.05）. Conclusion The use of Lappaconitine in preemptive analgesia had excellent effect in relieving acute pain in perioperative period,consummating PCA＇s analgesia effect and inhibiting the oxidative stress after surgery.