椎旁阻滞联合椎管内麻醉对全髋关节置换术患者应激反应和疼痛的影响  

Effects of Paravertebral Block Combined with Intraspinal Anesthesia on Stress Reaction and Pain in Patients with Total Hip Replacement

作　　者：薛强[1] 郑继根 钟传礼 XUE Qiang;ZHENG Ji-gen;ZHONG Chuan-li(Department of Anesthesiology,Central Hospital of Panzhihua City,Panzhihua,Sichuan 617067,China;the Second Department of Osteology,People＇s Hospital of Yubei District in Chongqing,Chongqing401120,China)

机构地区：[1]攀枝花市中心医院麻醉科,四川攀枝花617000 [2]重庆市渝北区人民医院骨二科,重庆401120

出　　处：《解放军医药杂志》2018年第8期58-62,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：重庆市医学科研计划项目(20142182)

摘　　要：目的探讨椎旁阻滞联合椎管内麻醉对全髋关节置换术患者应激反应和疼痛的影响。方法选取2017年1月—2018年1月攀枝花市中心医院收治的全髋关节置换术80例,每组40例。2组均在椎管内麻醉下行全髋关节置换术,观察组在椎管内麻醉基础上给予椎旁阻滞,对照组术后给予药物镇痛。观察并比较2组术后应激反应、视觉模拟疼痛评分、康复情况和并发症、血流动力学和不良反应发生情况。结果 2组术前C反应蛋白(CRP)和血管紧张素II(Ang II)水平比较差异无统计学意义(P>0.05)。2组术后24 h的CRP及Ang II水平高于术前,且观察组CRP及Ang II水平显著低于对照组(P<0.05);术后24 h观察组疼痛视觉模拟评分显著低于对照组(P<0.05)。2组出院时间、术后并发症、术中血流动力学和不良反应比较差异均无统计学意义(P>0.05)。结论椎旁阻滞可以降低全髋关节置换术患者术后应激反应和疼痛评分,值得进一步推广。Objective To investigate effects of paravertebral block combined with intraspinal anesthesia on stress reaction and pain in patients with total hip replacement. Methods A total of 80 patients with total hip arthroplasty admitted during January 2017 and January 2018 were performed operations under intraspinal anesthesia. Observation group （n =40） was given paravertebral block, while control group （n =40） received postoperative analgesia with drugs. Post- operative stress reaction, visual analogue scales （VAS） score, rehabilitation and complications conditions, helnodynaln- ics and incidence rate of adverse reactions were observed and compared in two groups. Results There were no signifi- cant differences in preoperative C-reactive protein （CRP） and angiotensin II （AngII） between two groups （P 〉 0.05）. At 24 h after operation, CRP and AnglI levels were significantly higher than those before operation in two groups, and the levels in observation group were significantly lower than those in control group （P 〈 0.05） ; VAS score in observation group was significantly lower than that in eontrol group （P 〈 0. 05）. There were no significant differenees in discharge time, postoperative complications, intraoperative hemodynamics and incidence rate of adverse reactions between two groups （P 〉0.05）. Conclusion Paravertebral block may decrease postoperative stress reaction and pain score in pa- tients with total hip replacement.

关 键 词：关节成形术 置换 髋 殷骨头坏死 椎旁阻滞 疼痛 

分 类 号：R687.42[医药卫生—骨科学]