2种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  

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

作　　者：彭明[1] 刘荣[1] 肖金辉[1] 吴敏[1] PENG Ming;LIU Rong;XIAO Jin-hui;WU Min(Department of Anesthesiology, the 908th Hospital of PLA Joint Logistical Support Force, Jiangxi Province, Yingtan 335000, China)

机构地区：[1]中国人民解放军联勤保障部第九〇八医院鹰谭医疗区麻醉科,江西鹰潭335000

出　　处：《河北医科大学学报》2021年第1期71-76,共6页Journal of Hebei Medical University

基　　金：鹰潭市指导性科技计划项目(Ykz20180058)。

摘　　要：目的探讨2种麻醉策略对下肢骨折患者术后镇痛效果、炎性反应及血管内皮功能的影响。方法选取收治的行切开内固定术的下肢骨折患者86例。根据不同麻醉策略将其分为静脉全身麻醉组(全麻组)和腰硬联合麻醉组(联合麻醉组),每组43例。全麻组采用丙泊酚+舒芬太尼策略,联合麻醉组0.75%罗哌卡因+舒芬太尼策略,2组术后均采用静脉自控镇痛。比较2组麻醉效果,麻醉前(T0)、术后即刻(T1)、术后6 h(T2)、术后24 h(T3)及术后72 h(T4)疼痛评分、炎症因子、血管内皮功能因子变化。结果联合麻醉组的麻醉效果(Ⅲ级:86.02%)明显优于全麻组(Ⅲ级:60.47%),差异有统计学意义(P<0.05)。T1~T4时刻,2组视觉模拟评分法(visual analogy scoring,VAS)评分均呈现进行性下降,血管内皮生长因子(vascular endothelial growth factor,VEGF)进行性升高(P<0.05),但联合麻醉组VAS评分均低于全麻组,VEGF高于全麻组(P<0.05);T1~T3时刻,2组肿瘤坏死因子α(tumor necrosis factorα,TNF-α)、白细胞介素6(interleukin-6,IL-6)、高敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、血皮质醇(compound F,FC)及血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)均升高,并均在T2时刻达到最高水平后开始下降,在T4时刻均低于T0时刻(P<0.05),联合麻醉组TNF-α、IL-6、hs-CRP、FC、AngⅡ水平在T1~T4时刻均低于全麻组(P<0.05)。结论静脉全身麻醉和腰硬联合麻醉均具有良好的麻醉效果,相较于静脉全身麻醉,腰硬联合麻醉在提高下肢骨折患者术后镇痛效果、减轻术后炎性反应和改善血管内皮功能方面的作用效果更为显著。Objective To investigate the effects of two anesthesia strategies on postoperative analgesia,inflammatory response and vascular endothelial function in patients with lower extremity fracture.Methods A total of 86 patients with lower extremity fracture who underwent open internal fixation were selected.According to different anesthesia strategies,they were divided into intravenous general anesthesia group(n=43)and combined spinal epidural anesthesia group(n=43).In general anesthesia group,propofol+sufentanil strategy was used,and 0.75%ropivacaine+sufentanil strategy was used in combined spinal epidural anesthesia group.The anesthetic effects of the two groups were compared.Before anesthesia(T0),immediately after operation(T1),at 6 h after operation(T2),24 h after operation(T3)and 72 h after operation(T4),changes in pain scores,inflammatory factors and vascular endothelial function factors were compared.Results The anesthesia effect of the combined anesthesia group(gradeⅢ:86.02%)was significantly better than that of the general anesthesia group(gradeⅢ:60.47%),and the difference was statistically significant(P<0.05).At T1-T4,the visual analogy score(VAS)of the two groups showed a progressive decrease whereas vascular endothelial growth factor(VEGF)showed a progressive increase(P<0.05).However,the VAS of the combined anesthesia group was lower,and VEGF was higher,as compared with those of the general anesthesia group(P<0.05).The levels of tumor necrosis factorα(TNF-α),interleukin-6(IL-6),hypersensitive C reactive protein(hs CRP),VEGF,compound F,(FC),and angiotensinⅡ(AngⅡ)in the two groups were increased from T1 to T3,and began to decrease after reaching the highest level at T2,and decreased at T4,which were lower than those at T0(P<0.05),while the levels of TNF-α,IL-6,hs-CRP,FC,and AngⅡin the combined anesthesia group were lower than those in the general anesthesia group at T1-T4(P<0.05).Conclusion Both intravenous general anesthesia and combined spinal and epidural anesthesia have good anesthetic effect

关 键 词：骨折 麻醉和镇痛 内皮 血管 

分 类 号：R683.42[医药卫生—骨科学] R614[医药卫生—外科学]