超声定位下“三叶草”法腰丛阻滞对全髋关节置换术患者应激反应、炎症状态及疼痛应激因子的影响  

Effect of“Shamrock”lumbar plexus block under ultrasound localization on stress response,inflammatory state and pain stress factors in patient with total hip arthroplasty

作　　者：孟华 刘文娜 MENG Hua;LIU Wen-na(Department of Orthopedics,Xingtai General Hospital of North China Medical and Health Group,Xingtai 054000,Hebei,China)

机构地区：[1]华北医疗健康集团邢台总医院骨科,河北邢台054000

出　　处：《生物医学工程与临床》2023年第5期638-644,共7页Biomedical Engineering and Clinical Medicine

基　　金：河北省卫健委2020年度医学科学研究课题计划项目(20201268)。

摘　　要：目的探讨对全髋关节置换术采用超声定位下“三叶草”法腰丛阻滞对患者的安全性和可行性。方法选择2021年3月至2022年3月接受全髋关节置换术治疗860例髋关节骨折患者,其中男性469例,女性391例;年龄35~70岁,平均年龄64.87岁;心功能分级(NYHA)Ⅱ级319例,Ⅲ级274例,Ⅳ级267例。根据随机数字表法将其分为研究组430例和对照组430例。对照组行超声引导下髂筋膜间隙阻滞,研究组接受超声定位下“三叶草”法腰丛阻滞。观察两组术中效果(异丙酚泵入量、关节腔灌洗液用量、手术时间、术中出血量、镇痛满意率、苏醒期躁动发生率和拔除喉罩时间)和术后转归情况[术后静脉自控镇痛(PCIA)用量、拔管时间、住院时间及下床活动时间],并比较两组患者术后外周血中应激反应指标、炎性因子及疼痛应激因子含量。结果研究组术中使用异丙酚量、灌洗液量和术中出血量均明显少于对照组,且拔除喉罩时间、手术时间更短,苏醒期躁动发生率更低,镇痛满意率更高[(115.61±18.44)mg vs(128.17±23.36)mg、(8.73±1.63)L vs(9.65±1.68)L、(12.31±3.36)min vs(14.06±3.32)min、(142.39±50.61)min vs(189.32±71.48)min、(271.35±90.59)mL vs(309.03±91.41)mL、7.67%vs 32.79%、98.14%vs 73.49%。P<0.05]。研究组术后静脉自控镇痛(PCIA)用量、下床活动时间、拔管时间及住院时间均较对照组显著减少[(56.52±2.23)mL vs(77.73±3.15)mL、(3.96±1.07)d vs(6.18±1.21)d、(8.18±2.16)min vs(23.66±3.15)min、(5.09±2.88)d vs(7.43±1.27)d。P<0.05]。研究组术后1 d、术后3 d血清生长激素(GH)、促肾上腺皮质激素(ACTH)、肿瘤细胞因子α(TNF-α)、细胞间黏附分子1(ICAM-1)、前列腺素E2(PGE2)、血清P物质(SP)及β-内啡肽(β-EP)水平均明显低于对照组[(2.97±0.34)ng/L vs(4.94±0.57)ng/L、(2.13±0.32)ng/L vs(3.55±0.48)ng/L、(27.62±4.21)ng/L vs(34.83±4.92)ng/L、(22.14±3.45)ng/L vs(29.32±3.61)ng/L、(7.62±0.91)μg/L vs(11.56±Objective To investigate the safety and effect of“Shamrock”lumbar plexus block under ultrasound localization on stress response,inflammation and pain stress factors in patient with total hip arthroplasty.Methods From March 2021 to March 2022,a total of 860 patients with total hip arthroplasty were enrolled,which included 469 males and 391 females,aged 35-70 years old with mean age of 64.87 years old.According to New York Heart Association(NYHA)functional grading,there were 319 cases of gradeⅡ,274 of gradeⅢand 267 of gradeⅣ.All of them were divided into study group(n=430)and control group(n=430)by random number table.The control group was treated with ultrasound-guided iliac fascial space block,and study group performed ultrasound-guided“Shamrock”lumbar plexus block.The intraoperative effects(propofol pumping volume,articular cavity lavage fluid volume,operation time,intraoperative bleeding loss,analgesia satisfaction rate,incidence of agitation during awakening period and laryngeal mask removal time)and postoperative outcomes[postoperative patient-controlled intravenous analgesia(PCIA)volume,extubation time,hospitalization time and ambulation time]of 2 groups were observed,and the stress response indexes,inflammatory factors and pain stress factors in postoperative peripheral blood between 2 groups were compared.Results The propofol amount,lavage fluid amount and intraoperative bleeding loss amount in study group were significantly less than those in control group,and removal laryngeal mask time,operation time were shorter,incidence of agitation during awakening period was lower,and satisfaction rate of analgesia was higher in study group than in control group[(115.61±18.44)mg vs(128.17±23.36)mg,(8.73±1.63)L vs(9.65±1.68)L,(12.31±3.36)minutes vs(14.06±3.32)minutes,(142.39±50.61)minutes vs(189.32±71.48)minutes,(271.35±90.59)mL vs(309.03±91.41)mL,7.67%vs 32.79%,98.14%vs 73.49%.P<0.05].The dosage of PCIA,ambulation time,extubation time and hospitalization time in study group were significantl

关 键 词：超声定位 “三叶草”法 腰丛阻滞 全髋关节置换术 应激反应 炎症状态 疼痛应激因子 

分 类 号：R614[医药卫生—麻醉学]