连续腰丛阻滞镇痛对下肢关节置换后疼痛及C反应蛋白和白细胞介素6表达的影响  

Effect of Continuous Lumbar Plexus Block Analgesia on Pain and Inflammatory Factors after Lower Extremity Joint Replacement

作　　者：卢希[1] 王祥静 林芩[1] LU Xi;WANG Xiangjing;LIN Qin(Department of Anesthesiology, The Affiliated People′s Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou 350004, China)

机构地区：[1]福建中医药大学附属人民医院麻醉科,福州350004

出　　处：《福建医科大学学报》2020年第6期441-443,共3页Journal of Fujian Medical University

基　　金：福建省中青年教师教育科研项目(科技类)(JAT170278)。

摘　　要：目的观察连续腰丛神经阻滞镇痛对下肢关节置换术后早期功能锻炼后疼痛及C反应蛋白和白细胞介素6表达的影响。方法选择择期行单侧下肢关节置换手术的患者60例,并根据随机数字表分为连续腰丛神经阻滞镇痛(PCNA)组和连续静脉镇痛(PCIA)组。两组患者均持续镇痛4 d且进行早期功能锻炼。通过随访获得两组患者术后1~5 d的疼痛视觉模拟评分(VAS),分别于术前1天及术后第1、3天抽取外周血,测定血清中C反应蛋白(CRP)和白细胞介素6(IL-6)水平。结果(1)两组术后第2天的VAS评分均较同组其他时间点明显升高(P<0.05);术后第1~3天,PCNA组的VAS评分均低于PCIA组(P<0.05)。(2)两组术后第3天的CRP均高于同组其他时间点(P<0.05),且PCNA组低于PCIA组(P<0.05)。(3)两组术后的IL-6均较术前增高(P<0.01),术后第1、3天,PCNA组的IL-6低于PCIA组(P<0.05)。(4)PCNA组的自控加药次数少于PCIA组(P<0.05)。结论与PCIA比较,PCNA可以减轻患者下肢关节置换手术后早期功能锻炼时的疼痛,减少炎性因子(IL-6及CRP)的释放,利于术后早期功能锻炼。Objective To observe the effect of continuous lumbar plexus block analgesia on pain and inflammatory factors after early functional exercise after lower limb joint replacement.Methods 60 patients with unilateral lower extremity arthroplasty were selected.Patients were randomly divided into continuous lumbar plexus block analgesia(PCNA)group and continuous intravenous analgesia(PCIA)group according to the random number table.Patients in both groups were given continuous analgesia for four days and were required to exercise early after operation.VAS scores of pain were obtained from day 1 to day 5 after operation.Peripheral blood samples were taken 1 day before operation and 1 and 3 days after operation to determine the levels of C-reactive protein(CRP)and interleukin-6(IL-6).Result(1)On the second day after operation,the VAS score of PCNA group was significantly lower than that of PCIA group(P<0.05);the VAS score of PCNA group was significantly lower than that of PCIA group(P<0.05);(2)On the third day after operation,Level of CRP was significantly higher than that at other time points in the same group(P<0.05),and the level of VAS in PCNA group was significantly lower than that in PCIA group(P<0.05).(3)Levels of IL-1 in both groups were significantly higher than before operation(The PCNA group was significantly lower than the PCIA group on the first and third days after operation(P<0.05).(4)The number of self-control dosing:PCNA group was significantly less than PCIA group(P<0.05).Conclusion Compared with continuous intravenous analgesia,continuous lumbar plexus block can reduce the pain of early functional exercise after lower limb joint replacement surgery,reduce the release of pro-inflammatory factors,which is conducive to early postoperative functional exercise and long-term rehabilitation.

关 键 词：神经传导阻滞 腰骶丛 手术后期间 疼痛 手术后/治疗 C反应蛋白 白细胞介素6 

分 类 号：R322.85[医药卫生—人体解剖和组织胚胎学] R614[医药卫生—基础医学]