超声引导下神经阻滞对四肢骨科手术后患儿血清疼痛介质水平研究  

Study on the effects of ultrasound-guided nerve block on the levels of serum pain medium of children post orthopedic surgery for four limbs

作　　者：林颖 王春光 陈霞 梁淑敏 唐貌 LIN Ying;WANG Chun-guang;CHEN Xia(Department of Anesthesia,Liuzhou Worker's Hospital,Liuzhou 545005,China)

机构地区：[1]柳州市工人医院麻醉科,广西柳州545005

出　　处：《中国医学装备》2020年第12期88-92,共5页China Medical Equipment

基　　金：广西壮族自治区卫生和计划生育委员会科研项目(Z20180514)“超声引导下神经阻滞在学龄前及学龄期儿童四肢骨科手术术后镇痛临床研究”。

摘　　要：目的:探究超声引导下神经阻滞对学龄前及学龄期儿童四肢骨科手术后血清中疼痛介质P物质(SP)和β-内啡肽(β-EP)水平的影响。方法:选取在医院接受治疗的92例四肢骨科手术后患儿,按照随机数表法将其分为对照组和观察组,每组46例。对照组采用静脉自控镇痛,观察组采用超声引导下神经阻滞镇痛。术前及术后24h抽取两组患儿肘部静脉血,采用酶联免疫吸附法测定其血清SP、β-EP、白介素-2(IL-2)、白介素-6(IL-6)、肿瘤坏死因子α(TNF-α)以及超敏C反应蛋白(hs-CRP),应用疼痛视觉模拟量表(VAS)评估患儿疼痛程度,Ramsay镇静评分评估患儿清醒程度。结果:术前两组患儿血清SP、β-EP、IL-2、IL-6、TNF-α、hs-CRP、VAS以及Ramsay镇静评分比较,差异无统计学意义;术后,治疗后观察组和对照组患儿血清SP、β-EP及VAS均低于治疗前,两组比较差异有统计学意义(t=3.348,t=2.726,t=3.937;P<0.05);IL-2、IL-6及hs-CRP均升高,且观察组升高低于对照组,其差异有统计学意义(t=4.633,t=9.421,t=11.529;P<0.05);TNF-α手术前后差异无统计学意义;治疗后观察组和对照组患儿不良反应发生率分别为6.52%和17.39%,且观察组低于对照组,其差异有统计学意义(x2=15.971;P<0.05);Ramsay镇静评分,术后观察组与对照组相比差异无统计学意义。结论:超声引导下神经阻滞有效抑制学龄前及学龄期儿童四肢骨科手术疼痛和炎症反应状态,有效缓解疼痛引起的应激反应,并降低不良反应发生率,具有一定临床应用价值。Objective:To investigate the effects of ultrasound-guided nerve block on the levels of serum pain medium such as substance P(SP)andβ-endorphin(β-EP)in preschool and school-age children post orthopedic surgery for four limbs.Methods:92 children post orthopedic surgery for four limbs were selected as subjects of study.And they were divided into control group and observation group according to random number table method,with 46 cases in each group.The control group adopted patient controlled intravenous analgesia(PCIA),and the observation group adopted ultrasound-guided nerve block for analgesia.Elbow venous blood samples were taken from children before and 24 hours after operation.Serum SP,β-EP,interleukin-2(IL-2),interleukin-6(IL-6),tumor necrosis factor alpha(TNF-α)and hypersensitive C-reactive protein(hs-CRP)were determined by enzyme linked immunosorbent assay(ELISA).And visual analogue scale of pain was applied to assess pain degree of children,and Ramsay composure score was used to assess the sober degree of children.Results:Before surgery,the differences of serum SP,β-EP,IL-2,IL-6,TNF-α,hs-CRP,VAS and Ramsay scores between the two groups were no significant.And the serum SP,β-EP and VAS of observation group and control group after surgery were lower than those before treatment.And the differences of these indicators between the two groups were significant(t=3.348,t=2.726,t=3.937,P<0.05).And the values of IL-2,IL-6 and hs-CRP increased after treatment,and the enhances of these indicators of observation group was significantly lower than those of control group(t=4.633,t=9.421,t=11.529,P<0.05).There was no statistical significance in TNF-αbetween before and after surgery.After treatment,the incidence of adverse reactions of observation group and control group were 6.52%and 17.39%,respectively,and that of observation group was significantly lower than that of control group(x2=15.971,P<0.05).The difference of Ramsay score after operation between observation group and control group was no significant.Conclu

关 键 词：超声引导 神经阻滞 学龄前及学龄期儿童 四肢骨科手术 疼痛介质 炎症因子 术后镇痛 

分 类 号：R445.1[医药卫生—影像医学与核医学]