PENGB联合椎管内麻醉对全髋关节置换术患者术后镇痛效果和血清炎症因子水平的影响  

Effects of pengb combined with spinal anesthesia on postoperative analgesia and serum inflammatory factors in patients undergoing total hip arthroplasty

作　　者：王雨广[1] 么静光 孙丙亮 杜宁[1] 王辉[1] WANG Yuguang;MIAO Jingguang;SUN Bingliang;DU Ning;WANG Hui(Anesthesiology Department of Tangshan Second Hospital,Tangshan 063000,China)

机构地区：[1]河北省唐山市第二医院麻醉科,0630000

出　　处：《中国煤炭工业医学杂志》2024年第2期147-151,共5页Chinese Journal of Coal Industry Medicine

基　　金：2019年度河北省“三三三人才工程”项目(编号:A201901124)。

摘　　要：目的 探讨髋关节囊周围神经阻滞(PENGB)对全髋关节置换术(THA)患者术后镇痛效果的影响。方法 随机选取2021年1月—2022年12月该院THA术后患者92例,随机分为对照组与观察组,各46例。对照组予以髂筋膜间隙阻滞(FICB)联合椎管内麻醉,观察组予以PENGB联合椎管内麻醉。并于术后4h、8h、24h及48h记录二组患者的疼痛评分;对二组患者术后48h内镇痛泵按压次数以及补救镇痛率进行统计分析;分别于术后4h、8h、24h及48h对患者股四头肌肌力进行评定;记录二组术后首次下床步行时间、步行距离以及术后住院时间;分别于术前和术后1d,检测患者血清白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)。结果 对于活动状态VAS评分的结果,与对照组比较,观察组术后4h、8h和24h均显著降低(P<0.05)。二组各时间点静息状态疼痛评分差异无统计学意义(P>0.05)。对于镇痛泵按压次数的结果,与对照组比较,观察组48h的次数显著减少(P<0.05),补救镇痛率显著降低(P<0.05)。观察组术后4h、8h和24h股四头肌肌力的结果,与对照组比较显著增高(P<0.05)。与对照组比较,观察组术后首次步行时间明显提前(P<0.05),首次步行距离显著提高(P<0.05),且术后住院时间缩短(P<0.05)。与术前比较,二组术后1d血清IL-6和TNF-α检测水平均显著增高(P<0.05)。与对照组比较,观察组以上炎症指标显著降低(P<0.05)。结论 PENGB联合椎管内麻醉用于THA术,在术后镇痛效果、术后活动时疼痛、改善下肢肌力、抑制炎症反应等方面均优于FICB联合椎管内麻醉,能够促进患者早期恢复。Objective To investigate the effect of peripheral nerve block(PENGB)on postoperative analgesia in patients undergoing total hip arthroplasty(THA).Methods Ninety-two patients after THA were randomly divided into control group and observation group,46cases in each.Patients in control group were given fascia iliaca compartment block(FICB)combined with spinal anesthesia,and patients in observation group were given PENGB combined with spinal anesthesia.The pain scores of two groups were recorded at 4h,8h,24hand 48hafter operation.The quadriceps strength was evaluated at 4h,8h,24hand 48hafter operation.The first ambulation time,walking distance and postoperative hospital stay of two groups were recorded.Serum levels of IL-6and TNF-αwere measured before and 1day after surgery.Results Compared with control group,VAS score of active state in observation group decreased significantly at 4h,8hand 24hafter operation(P<0.05).There were no significant differences in resting-state pain scores between two groups at each time point(P>0.05).The results of pressing times of analgesic pump showed that the number of pressing times in 48hours in observation group was significantly lower than that in control group(P<0.05),and the requirement for rescue analgesia was significantly reduced(P<0.05).The muscle strength of quadriceps femoris in observation group increased significantly at 4h,8hand 24hafter operation(P<0.05).The first walking time showed that observation group was significantly earlier after surgery(P<0.05),and the first walk distance increased significantly(P<0.05).Postoperative hospital stay in observation group was shorter than that in control group(P<0.05).Compared with pre-operation,the serum IL-6and TNF-αlevels of two groups were significantly increased on the first day after operation(P<0.05).Compared with control group,the above inflammatory indexes in observation group were significantly decreased(P<0.05).Conclusion PENGB combined with intraspinal anesthesia for THA can improve postoperative analgesia,relieve pain

关 键 词：全髋关节置换术 神经阻滞 髂筋膜间隙阻滞 髋关节囊周围神经阻滞 术后疼痛 炎症反应 

分 类 号：R614[医药卫生—麻醉学]