不同麻醉策略对下肢骨折患者术后镇痛、炎性反应及血管内皮功能的影响  

Effects of different anesthesia strategies on postoperative analgesia,inflammatory response and vascular endothelial function in patients with lower extremity fractures

作　　者：王敏华 徐桂菊 肖金辉[1] FANG Minhua;XU Guiju;XIAO Jinhui(Department of Anesthesia,No.184 Hospital of PLA,Jiangxi,Yingtan 335000,China)

机构地区：[1]中国人民解放军第184医院麻醉科,江西省鹰潭市335000

出　　处：《河北医药》2018年第18期2739-2742,共4页Hebei Medical Journal

摘　　要：目的研究不同麻醉策略对下肢骨折患者术后镇痛作用、炎性反应及血管内皮功能的影响。方法 76例下肢骨折患者,按照随机盲法分为联合组和全麻组,每组38例。采用静脉全麻术为全麻组,采用腰硬联合麻醉为联合组,同时术后结合自控静脉镇痛,分析2组患者视觉模拟评分法(VAS)、超敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及血管内皮功能情况。结果麻醉后,联合组患者的Bromage评分、麻醉效果均优于全麻组,差异有统计学意义(P<0.05)。T0时,2组患者VAS评分、hs-CRP、IL-6、TNF-α、血管紧张素Ⅱ、血皮质醇与血管内皮生长因子(VEGF)比较差异无统计学意义(P>0.05);术后T1~T4,2组患者VAS评分组内、组间比较差异有统计学意义(P<0.05)。术后T1~T4,2组患者以上所有指标(除VEGF)均在T2达到最大,随后迅速下降,而VEGF随着时间延长逐渐上升,与T0比较均差异有统计学意义(P<0.05)。结论对下肢骨折患者,采用腰硬联合麻醉术明显优于全麻术,术后镇痛效果良好,炎性反应降低,血管内皮功能改善,预后良好。Objective To observe the effects of different anesthesia strategies on postoperative analgesia,inflammatory response and vascular endothelial function in patients with lower extremity fractures. Methods A total of 76 patients with lower extremity fractures who were admitted and treated in our hospital from August 2016 to October 2016 were enrolled in the study. According to randomized blindness method,these patients were divided into combination anesthesia group and general anesthesia group,with 38 patients in each group. The patients in general anesthesia group were treated by intravenous anesthesia,however,the patients in combination anesthesia group were treated by combined lumbar and thoracic anesthesia,with self-controlled intravenous analgesia after operation. The visual analogue scale（VAS）,hypersensitive C-reactive protein（hs-CRP）,interleukin-6（IL-6）,tumor necrosis factor-α（TNF-α） and endothelial function were observed and compared between two groups. Results After anesthesia,the Bromage scores and anesthesia effects in combination anesthesia group were superior to those in general anesthesia group（P〈0. 05）. There were no significant differences in VAS scores,hs-CRP,IL-6,TNF-α,angiotensin II,blood cortisol and vascular endothelial growth factor（VEGF） at T0 between the two groups（P〈0. 05）,however,there were significant differences in VAS scores at T1 ~ T4 after operation between the two groups（P〈0. 05）. Except for VEGF the other indexes mentioned above at T2 after operation reached peak in both groups,then which were decreased rapidly,however VEGF levels were increased with the time going on,as compared with those at T0（P〈0. 05）. Conclusion For patients with lower extremity fractures,combined lumbar and thoracic anesthesia is superior to general anesthesia,the former has the advantages of good postoperative analgesic effects,lower inflammatory response,obvious improvement of vascular endothelial function and good prognosis of patients.

关 键 词：麻醉策略 下肢骨折 镇痛 炎性反应 血管内皮功能 

分 类 号：R614[医药卫生—麻醉学]