| OBJECTIVE: To investigate the the reasonable analgesic dose of hydromorphone hydrochloride alone or combined dexmedetomidine(DEX)in elderly patients after hip joint surgery.METHODS: In the first part: 120 elderly patients who underwent elective total hip arthroplasty in our hospital from January 2016 to April 2016 were randomly divided into 6 groups: 0.020mg/ml hydromorphone hydrochloride,0.035mg/ml hydromorphone hydrochloride,0.050mg/ml hydromorphone hydrochloride,0.065mg/ml hydromorphone hydrochloride,0.080mg/ml hydromorphone hydrochloride and 0.095mg/ml hydromorphone hydrochloride.Interleukin-1b(IL-1?),Interleukin-6(IL-6)and tumor necrosis factor-?(TNF-?)in serum,systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)VAS,Ramsay,postoperative cognitive function(POCD),adverse reactions and patient satisfaction were measured at different times.In the Second part: 120 elderly patients who underwent elective hip arthroplasty from May 2016 to September 2016 were randomly divided into 6groups : Hydromorphone hydrochloride 0.020mg/ml + DEX 0.50?g/kg/d,hydromorphone hydrochloride 0.035mg/ml + DEX 0.50?g/kg/d,hydromorphone0.050mg/ml + DEX 0.50?g/kg/d,hydromorphone 0.065mg/ml + DEX 0.50?g/kg/d,hydromorphone 0.080 mg/ml + DEX 0.50?g/kg/d,hydromorphone 0.095mg/ml +DEX 0.50?g/kg/d.The detection indexes were the same as the first part.RESULTS: In the first part There had no significant difference in the blood viscosity of 6 groups before operation(P <0.05).After operation,the blood viscosity had decreased in a way of hydromorphone dose dependence.The blood viscosity in0.020mg/ml~0.050mg/ml groups and 0.065mg/ml~0.095mg/ml groups were comparable.Compared with 0.020mg/ml~0.050mg/ml groups,the blood viscosity had decreased in the 0.065mg/ml~0.095mg/ml groups(P<0.05).There had no significant difference in the inflammatory factors before operation(P> 0.05).1 day and 3 days after operation,the inflammatory factors had increased(P<0.05).The inflammatory factors had decreased in a way of hydromorphone dose dependence.The inflammatory factors in 0.020mg/ml~0.050mg/ml groups and0.065mg/ml~0.095mg/ml groups were comparable.Compared with0.020mg/ml~0.050mg/ml groups,the inflammatory factors had decreased in the0.065mg/ml~0.095mg/ml groups(P<0.05).There had no significant difference in SBP and DBP before and after oparation within 6 groups(P> 0.05).The HR in0.020mg/ml~0.050mg/ml groups and 0.065mg/ml~0.095mg/ml groups were comparable.Compared with 0.020mg/ml~0.050mg/ml groups,the HR had decreased in the 0.065mg/ml~0.095mg/ml groups(P<0.05).The VAS of 6 groups had decreased in a way of hydromorphone dose dependence.The VAS in 0.020mg/ml~0.050mg/ml groups and 0.065mg/ml~0.095mg/ml groups were comparable.Compared with0.020mg/ml~0.050mg/ml groups,the VAS had decreased in the0.065mg/ml~0.095mg/ml groups(P<0.05).The ED50 and ED95 of hydromorphone along was 0.0381 mg/ml and 0.0530 mg/ml,respectively.The Ramsay in0.020mg/ml ~ 0.035mg/ml had significantly increased(P <0.05)and had decreased in the 0.065mg/ml~ 0.095mg/ml.Till 36 hour,except 0.020mg/ml group,the Ramsay in all groups had returned to normal,0.050mg/ml group did not change in all time(P> 0.05).Compared with before operation,the POCD of 6 groups had decreased(P<0.05).Compared with the 0.020mg/ml group,POCD in 0.035mg/ml~0.095mg/ml had decreased(P <0.05).POCD in 0.035mg/ml~0.050mg/ml groups reach normal.Vomiting occurred more in 0.020mg/ml ~ 0.035mg/ml groups,lethargy,nausea,vomiting,skin itching and respiratory depression occurred more in0.065mg/ml~0.095mg/ml groups.Lest side effects occured in 0.050mg/ml group(P<0.05).The lest postoperative analgesia satisfaction was in 0.020mg/ml~0.035mg/ml groups.The highest postoperative analgesia satisfaction was in0.050mg/ml~0.095mg/ml groups.Satisfaction score had no statistical differences within 0.050mg/ml~0.095mg/ml groups(P> 0.05).In the second part There had no significant difference in the blood viscosity within 6 groups before operation(P >0.05).The blood viscosity had decreased in a way of hydromorphone dose dependence.Compared with 0.020mg/ml+DEX group,the blood viscosity in 0.035mg/ml + DEX ~ 0.095mg/ml + DEX groups had decreased(P <0.05),but there had no significant difference in the blood viscosity within 0.035mg/ml + DEX ~ 0.095mg/ml + DEX groups.There had no significant differences in the inflammatory factors before operation within 6 groups(P <0.05).The inflammatory factors had decreased in a of hydromorphone dose dependence.Compared with Compared with 0.020mg/ml+DEX group,inflammatory factors in0.035mg/ml + DEX ~ 0.095mg/ml + DEX groups had decreased(P <0.05),but there had no significant difference in the inflammatory factors within 0.035mg/ml + DEX ~0.095mg/ml + DEX groups.Till 3 days,the inflammatory factors within 0.035mg/ml+ DEX ~ 0.095mg/ml + DEX groups had reached the level before operation.There had no significant difference of SBP and DBP in 6 groups bofere operation(P >0.05).Compared with 0.020mg/ml+DEX group,HR in 0.035mg/ml+DEX-0.095mg/ml+DEX had decrasesd(P <0.05),but there had no significant difference in HR within0.035mg/ml + DEX ~ 0.095mg/ml + DEX groups(P >0.05).Compared with0.020mg/ml+DEX group,VAS in 0.035mg/ml+DEX ~0.095mg/ml+DEX had decreased(P <0.05),but there had no significant difference in VAS within 0.035mg/ml+ DEX ~ 0.095mg/ml + DEX groups(P >0.05).The ED50 had not detected and ED95 was 0.038 mg/ml.The Ramsay of 0.020mg/ml + DEX ~ 0.095mg/ml + DEX group had increased(P>0.05).Compared with 0.020mg/ml + DEX group,the Ramsay in0.035mg/ml + DEX ~ 0.095mg/ml + DEX groups had increased(P <0.05).Compared with preoperative,POCD of 6 groups had decreased(P <0.05).Compared with0.020mg/ml+DEX group,POCD in 0.035mg/ml+DEX ~0.095mg/ml+DEX had decreasesd(P <0.05).The POCD in 0.035mg/ml-0.065mg/ml had reached normal.Vomiting occured more in 0.020mg/ml + DEX group.Drowsiness,nausea and vomiting and skin itching occured more in 0.050mg/ml+DEX ~0.095mg/ml+DEX groups.The 0.030mg/ml ~ 0.095mg/ml group had the highest satisfaction score(P<0.05),but there had no significant difference in the lest satisfaction score was0.020mg/ml + DEX group.CONCLUSION: The reasonable dosage of hydromorphone hydrochloride is0.050mg/ml,the volume is 100 ml.The ED50 of analgesic is 0.0381mg/ml,ED95 is0.0530mg/ml.Under 0.50?g / kg/d dexmedetomidine and hydromorphone hydrochloride,a reasonable dose of hydromorphone hydrochloride is 0.035 mg/ml,the volume is100 ml.For the elderly,hydromorphone hydrochloride combined with dexmedetomidine can significantly reduced the dosage of hydromorphone hydrochloride after hip surgery. |
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