| BackgroundWith the acceleration of the population aging process in our country and the increasing demand for medical treatment by the citizens,the visiting rate of patients undergoing joint replacement surgery is on the rise.In recent years,with the development and improvement of artificial joint materials and artificial knee arthroplasty,artificial knee arthroplasty has achieved remarkable clinical effects in the treatment of osteoarthritis,and has received close attention of clinicians and the height of patients Recognized.However,there will be severe pain after knee arthroplasty,and it will last more than 48 hours.It is a type of surgery with a high degree of postoperative pain.The good analgesic effect after knee arthroplasty is not only beneficial to the functional recovery of the joint,but also reduces the risk of thrombus and other related complications.It can also improve patient satisfaction and comfort.Therefore,perioperative analgesia for artificial joint replacement has always been one of the focus of clinical attention.The pain of super front town is to take analgesic measures before injurious stimulation,reduce the sensitivity of central and peripheral nerve,reduce the afferent of nociceptive stimulation,and achieve or eliminate the pain.However,as a large traumatic operation,the release of some components in the patient's body can lead to the occurrence of the stress response,and the sustained stress response can cause central sensitization.Before the injurious stimulation of the body,the application of super front pain can reduce the sensitivity of the peripheral and central nervous system,inhibit the plasticity of neurons,reduce the pain,and reduce the dosage of other analgesic drugs.Opioids are commonly used drugs for preemptive analgesia,and dezocine is a mixed opioid receptor agonist antagonist.Whether antinociceptive analgesia is effective or not is to check whether the stress reaction substance is inhibited in vivo.In this study,based on the concept of preemptive analgesia,the effect of preemptive analgesia on postoperative analgesia and stress hormone levels in patients with knee arthroplasty was studied by combined use of preemptive analgesia with preemptive analgesia in the knee arthroplasty.ObjectiveTo investigate the effects of dizocin on the levels of adrenocorticosteroid(ACTH)and cortisol(COR)stress hormones in perioperative blood of patients undergoing joint replacement and the occurrence of adverse reactions.The purpose is to provide scientific basis for the application of Dzosin advanced analgesia in joint replacement surgery,and to improve the comfort of surgical patients.MethodFrom March 2016 to December 2017 the choice of tracheal intubation treatment in Puyang Oilfield General Hospital of general anesthesia in 80 cases of patients with joint replacement surgery,according to the inclusion and exclusion criteria,20 patients withdrew from the study process,the actual included 60 patients,ASA I-II,40~70 years of age,body mass index 18 ~ 25 kg/m2.The patients were divided into the observation group(dezocine topical analgesia,30 cases)and the control group(only the same amount of normal saline,30 cases)by the random number table method..The patients were given regular fasting and drinking before operation.The noninvasive blood pressure(BP),electrocardiogram(ECG)and blood oxygen saturation(SpO2)were monitored in the right upper arm.The peripheral vein was opened,and 1% lidocaine local infiltration anesthesia was applied to puncture the artery puncture catheter to monitor the arterial blood pressure continuously.In the observation group,15 min were given lead analgesia before induction by intravenous injection of dizosin(BS1906,Chinese medicine standard H20080329)0.1 mg/kg,while in the control group,only the same amount of saline was injected.Observation group and control group were given total intravenous anesthesia by mask full oxygen,using Datex Ohmeda S/5Aespire intravenous anesthesia: etomidate(Jiangsu Heng Rui medical Limited by Share Ltd,batch number: B20160819,H32022379)0.15~0.3mg/kg,remifentanil(Yichang humanwell Pharmaceutical Co.Ltd.,batch number: 6171116,Zhunzi H20030197)1?g/kg,midazolam(Yichang humanwell Pharmaceutical Co.Ltd.1161101,batch number: Zhunzi A1,H20067040)0.05~0.1mg/kg,benzenesulphonyl cisatracurium(Jiangsu Hengrui pharmaceutical Limited by Share Ltd,batch number: Zhunzi A20150910,H20060869)0.3 ~ 0.4mg/kg,sufentanil(Yichang humanwell Pharmaceutical company,batch number: 1170302 A1,Zhunzi H20054172)1?g/kg.Breathing bag pressure 3min ventilation,using Shikani intraoral injection into the tracheal intubation,mechanical ventilation were successful,with 100% oxygen inhalation anesthesia machine during operation.The respiratory parameters were set: the respiratory frequency was 10~12 /min,the tidal volume was 6~8ml/kg,and the end expiratory carbon dioxide was maintained from 35 to 45 mmHg.Continuous infusion of propofol in the operation(Sichuan Guorui pharmaceutical limited liability company,batch number: 20160908,Zhunzi: H20040079)4~6mg/kg·h,remifentanil(Jiangsu nhwa pharmaceutical stock limited company,batch number: 20170506,Zhunzi H20143314)0.1 ~ 0.3?g /kg min.Continuous intravenous injection of cisatracurium besilate(Jiangsu Hengrui pharmaceutical Limited by Share Ltd,A20150910,batch number: Zhunzi H20060869)to maintain anesthesia,rehydration(according to the crystal gel than 1:1 principle),according to the hemodynamic parameters and adjust the liquid injection rate.The type of liquid input was consistent in the two groups.The pain visual simulation(VAS)score was performed at 1h(T1),6h(T2),12h(T3),and 24h(T4)at the end of the operation.The venous blood samples were extracted before and after anesthesia induction,endotracheal intubation,operation end and postoperative 1h,and the value of ACTH and COR in each period of blood was measured.And statistics the incidence of two groups of adverse events.ResultThe average age was(56.55 ± 8.28)years old,BMI(25.33 ± 3.34)kg / m2,ASA grade I in 16 cases,grade II in 14 cases,operation time(123.23 ± 13.56)min,and blood loss in operation(310.52 ± 56.89)ml.There were 17 males and 13 females in the control group,with an average age of(55.62 ± 9.66)years,BMI of 25.36 ± 4.32 kg / Cases,operation time(121.19 ± 12.85)min,intraoperative blood loss(315.78 ± 52.18)ml.There was no significant difference in age,sex and other general information between the two groups(P>0.05).(2)The score of VAS in observation group was significantly lower than that of control group within 24 h after operation,the difference was significant(P<0.05).(3)Before the induction of anesthesia,there was no significant difference in serum ACTH and COR between the observation group and the control group(P> 0.05);after tracheal intubation,at the end of surgery,1 hour after suigery,the serum of the observation group ACTH,COR levels were significantly lower than the control group(P <0.05).(4)The incidence of adverse reactions in the observation group and the control group were 13.33% and 36.67% respectively,the incidence of adverse reactions in the observation group was significantly lower than that in the control group(P<0.05).Conclusion(1)Dizocine Analgesia for knee arthroplasty can effectively reduce postoperative pain in patients with good analgesia(2)Preemptive analgesia with dezocine for knee arthroplasty can reduce the elevation of corticotropin and cortisol during perioperative period,and reduce the level of stress response.(3)Dezocine preemptive analgesia relieves adverse reactions such as nausea and vomiting caused by other anesthetics.High security. |
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