系统疼痛管理对老年髋部骨折手术患者应激反应及疼痛阈值的影响  

Effect of the system pain management on stress response,pain threshold in elderly patients undergoing hip fracture operation

作　　者：张理 蒋涛[1] 席小燕[1] ZHANG Li;JIANG Tao;XI Xiao-yan(Department of Orthopedics,the First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,China)

机构地区：[1]成都医学院第一附属医院骨科

出　　处：《创伤外科杂志》2019年第8期595-600,共6页Journal of Traumatic Surgery

基　　金：四川省教育厅科研课题(15ZA0265)

摘　　要：目的研究系统疼痛管理(SPM)对老年髋部骨折(HF)手术患者应激反应及疼痛阈值的影响。方法2016年1月—2018年12月成都医学院第一附属医院行手术治疗的老年HF患者182例,其中男性102例,女性80例;年龄63~87岁,平均72.4岁,体质量63.26~68.76kg,平均66.6kg;致伤原因:道路交通伤72例,摔伤68例,高处坠落伤38例,其他4例。采用随机数字表法分为行SPM 91例(SPM组)和行常规管理91例(常规组)。SPM组包括组建SPM管理小组、健康教育、疼痛评估、个性化镇痛、心理干预、药物干预、生活干预。观察两组患者手术当日、术后24、72h及出院当日VAS评分,术前及术后12、24、48h机械痛阈值,术前及术后2h血清晚期氧化蛋白(AOPP)、丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)等氧化应激因子水平,血清肾上腺素(E)、去甲肾上腺素(NE)、醛固酮(ALD)、皮质醇(Cor)等创伤应激因子水平,术前及术后7d白细胞介素-6(IL-6)、白细胞介素-17(IL-17)及C反应蛋白(CRP)等炎性因子水平。结果两组患者手术当日VAS评分差异无统计学意义[(3.88±0.40)分vs.(3.94±0.43)分,P>0.05];SPM组术后24、72h及出院当日VAS评分均小于常规组[(3.31±0.35)分vs.(3.60±0.38)分、(2.11±0.23)分vs.(3.02±0.32)分、(1.03±0.12)分vs.(2.01±0.22)分,P<0.05]。术前及术后12、24、48h,SPM组机械痛阈值均大于常规组[(7.17±0.72)g vs.(6.01±0.62)g、(15.83±0.17)g vs.(10.92±0.13)g、(16.97±1.73)g vs.(13.28±1.48)g、(18.52±1.95)g vs.(15.28±1.64)g,P<0.05]。术前SPM组血清AOPP、MDA、GSH-PX水平均低于常规组[(15.29±1.63)μmol/L vs.(18.42±1.92)μmol/L、(14.78±1.51)U/L vs.(17.95±1.84)U/L、(153.65±16.38)μg/mL vs.(170.52±17.28)μg/mL],SOD水平高于常规组[(33.07±3.42)μg/mL vs.(30.64±3.19)μg/mL,P<0.05];术后2h两组患者血清AOPP、MDA水平均高,SOD、GSH-PX较术前水平均低(P<0.05)。术前及术后2h,SPM组血清E、NE、ALD、Cor水平均低于常规组(P<0.05)Objective To study the effect of the System Pain Management(SPM)on stress response,pain threshold in elderly patients undergoing hip fracture(HF)operation.Methods A total of 182 cases of elderly patients undergoing hip fracture(HF)operation in our hospital from Jan.2016 to Dec.2018 were included in this study.Among them,91 cases were given SPM(SPM group)and 91 cases were given routine management(Routine group)using the random number table method.There were 102 males and 80 females.They were 63-87 years old,with an average of 72.3 years old,and their body mass was 63.26-68.75kg,with an average of 66.63kg.Factors causing injuries were:72 cases of road traffic injuries,68 cases of fall injuries,38 cases of fall injuries,and 4 cases of the other reasons.SPM group included SPM management group,health education,pain assessment,personalized analgesia,psychological intervention,drug intervention and life intervention.The pain score on the operation day,24h and 72h after operation,discharge day,mechanical pain threshold before operation and 12h,24h,48h after operation,before operation and 2h after operation,and the levels of oxidative stress factors such as serum advanced oxidation protein products(AOPP),malondialdehyde(MDA),superoxide dismutase(SOD),glutathione peroxidase(GSH-PX),and the levels of traumatic stress factor such as serum epinephrine(E),noradrenaline(NE),aldosterone(ALD),cortisol(Cor)before operation and 7d after operation,together with the levels of inflammatory factor such as serum interleukin-6(IL-6),interleukin-17(IL-17),C reactive protein(CRP)in the two groups were observed.Results On the operation day,no difference in pain score in the two groups were observed[(3.88±0.40)score vs.(3.88±0.40)score](P>0.05).At 24h,72h after operation,the discharge day,pain score in SPM group were lower than those in Routine group[(3.31±0.35)score vs.(3.60±0.38)score,(2.11±0.23)score vs.(3.02±0.32)score](P<0.05).Before operation and 12h,24h,48h after operation,mechanical pain threshold in SPM group were higher than

关 键 词：髋部骨折 系统疼痛管理 手术 应激反应 疼痛阈值 老年 

分 类 号：R47[医药卫生—护理学]