目的 探讨高乌甲素贴片在膝关节清理术后镇痛治疗的效果。方法 选择2014-06至2016-06收治的成人Kellgren分级Ⅰ~Ⅱ期膝关节骨性关节炎患者50例,随机分组为2组,分别为高乌甲素贴片组(LAC组)和对照组(CON组),每组25例。LAC组接受关节镜关节清理术后应用高乌甲素贴片联合盐酸哌替啶注射液行术后镇痛,CON组清理术后单独应用盐酸哌替啶注射液镇痛。应用VAS疼痛评分观察各组患者术后镇痛效果,于术后48 h采集各组患者的膝关节滑液,应用ELISA检测标本中IL-1β、透明质酸、基质金属蛋白酶-2和P2X3受体的表达差异。结果 与CON组[IL-1β (551.3±53.1)pg/ml、MMP2(10.412±1.169)ng/ml、HA(296.7±28.0)ng/ml和P2X3(1.041±0.095)2-ΔΔCt]比较,LAC组的VAS评分和膝关节滑液中的IL-1β(307.5±47.4)ng/ml、MMP2 (7.650±1.299)pg/ml、P2X3 (0.676±0.059)2-ΔΔCt明显下降,差异有统计学意义(P＜0.05),HA水平(353.7±37.4)ng/ml明显上调,差异有统计学意义(P＜0.05)。结论 高乌甲素贴片在膝关节清理术后镇痛中能明显减轻术后疼痛,可能通过调节MMP2的含量、增加HA分泌和降低P2X3受体的表达水平来干预膝关节骨性关节炎的炎性反应水平。
Abstract
Objective To investigate the clinical effect of lappaconitine adhesive patches in postoperative analgesia of knee arthroscopic debridement.Methods Fifty patients with knee osteoarthritis (Knee-OA) of Kellgren grade Ⅰ-Ⅱ were randomly divided into the lappaconitine adhesive patch treated group (LAC) and the control group (CON) (n=25 each). The patients of LAC group were treated with lappaconitine adhesive patches for postoperative analgesia after arthroscopic debridement while those of CON group were treated with normal adhesive patches as control. Patients with incomplete analgesia received intramuscular injection of meperidine hydrochloride. Synovial fluid was collected 2 days after arthroscopic debridement for determination of the expressions of interleukin-1 beta (IL-1β), hyaluronic acid (HA) and matrix metalloproteinase-2 (MMP-2) and P2X3 receptors by ELISA. The effect of postoperative analgesia was detected by VAS Scale.Results Compared with CON group[IL-1β (551.3±53.1) pg/ml,MMP2 (10.412±1.169) ng/ml,HA (296.7±28.0) ng/ml and P2X3(1.041±0.095)2-ΔΔCt], the concentrations of IL-1β(307.5±47.4) pg/ml, MMP-2(7.650±1.299) ng/ml and P2X3 receptor s(0.676±0.059)2-ΔΔCt decreased significantly in LAC group 2 days after surgery (P<0.05). The concentration of HA in synovial fluid increased significantly and excellent analgesia was observed in LAC group (353.7±37.4)ng/ml (P<0.05).Conclusions The lappaconitine adhesive patch can attenuate the secretion of IL-1β after Knee-OA and may regulate the secretion of HA, MMP-2 and P2X3 during the treatment of Knee-OA.
关键词
高乌甲素 /
关节镜清理术 /
基质金属蛋白酶-2 /
透明质酸 /
P2X3受体
Key words
lappaconitine /
arthroscopic debridement /
matrix metalloproteinase-2 /
hyaluronic acid /
P2X3 receptor
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