临床外科杂志 ›› 2023, Vol. 31 ›› Issue (4): 391-394.doi: 10.3969/j.issn.1005-6483.2023.04.025

• 论著 • 上一篇    下一篇

连续腰丛神经阻滞在髋关节置换术病人术后镇痛以及对炎症因子的影响

  

  1. 362000 福建泉州,联勤保障部队第910医院麻醉科 
  • 收稿日期:2022-07-04 接受日期:2022-07-04 出版日期:2023-04-25 发布日期:2023-04-25
  • 通讯作者: 朱燕华,Email:17875570@qq.com
  • 基金资助:
    福建省泉州市科技计划项目(2018Z151)

Continuous lumbar plexus block for postoperative analgesia in patients with hip arthroplasty and its effect on inflammatory factors

  1. Department of Anesthesiology,910 Hospital of the Joint Logistics Support Force,Fujian,Quanzhou 362000, China
  • Received:2022-07-04 Accepted:2022-07-04 Online:2023-04-25 Published:2023-04-25

摘要: 目的   探讨连续腰丛神经阻滞在髋关节置换术病人术后镇痛中的应用效果及对炎症因子的影响。  方法   2018年11月~2019年12月进行髋关节置换术的病人114例,根据病人术后采用的镇痛方式分为对照组和观察组,每组各57例。对照组术后采用自控静脉镇痛,观察组采用连续腰丛神经阻滞,术后3天对病人镇痛效果进行评估,比较两组视觉模拟疼痛(VAS)评分、术后炎症因子水平、简明智能量表(MMES)评估认知功能水平及安全性。  结果   观察组术后1、2、3天 VAS评分均低于对照组 ;观察组镇痛后3天炎症因子TNF-ɑ水平为(3.26±0.19)ng/L,IL-6水平为(1.55±0.12)ng/L,对照组分别为(5.49±0.23)ng/L和(2.63±0.14)ng/L,两组比较差异有统计学意义(P<0.05);观察组病人的IL-10水平为(4.79±0.23)ng/L,对照组为(2.48±0.19)ng/L,两组比较差异有统计学意义(P<0.05);观察组术后1天、2天 MMSE评分分别为(20.30±2.32)分和(21.35±2.33)分,高于对照组MMSE评分;观察组镇痛后下肢麻木、尿潴留、恶心呕吐及呼吸抑制发生率均低于对照组,差异有统计学意义(P<0.05)。  结论   连续腰丛神经阻滞用于髋关节置换术病人术后镇痛中能减轻病人疼痛,降低炎症因子水平,对病人认知功能影响较小,能降低并发症发生率。

关键词: 连续腰丛神经阻滞, 髋关节置换术, 术后镇痛, 应用效果, 视觉模拟疼痛评分, 炎症因子, 认知功能

Abstract: Objective   To investigate the effect of continuous lumbar plexus block in postoperative analgesia in patients with hip arthroplasty and its effect on inflammatory factors.  Methods   A retrospective analysis of 114 patients who underwent hip arthroplasty from November 2018 to December 2019 was used as the object,and they were divided into the control group and the observation group according to the postoperative analgesia,there were 57 patients in each group.The control group received patient-controlled intravenous analgesia after operation,and the observation group received continuous lumbar plexus block.The effect of the patients was evaluated 3 days after operation,and the visual analog pain (VAS) scores,postoperative inflammatory factor levels,and cognitive function levels were compared between the two groups.and safety.  Results   The VAS scores of the observation group were lower than those of the control group on the 1st,2nd and 3rd days after operation.The levels of inflammatory factors TNF-ɑ and IL-6 in the observation group[(3.26±0.19)ng/L,(1.55±0.12)ng/L] were lower than the control group patients[(5.49±0.23)ng/L,(2.63±0.14)ng/L](P<0.05).In the observation group,the IL-10 level of the patients was (4.79±0.23) ng/L,which was higher than that of the control group [(2.48±0.19) ng/L,P<0.05].The MMSE scores of the observation group at 1d and 2d before surgery were (20.30±2.32) score and (21.35±2.33) score,which were higher than the MMSE score of the control group; the incidences of lower limb numbness,urinary retention,nausea and vomiting and respiratory depression in the observation group after analgesia were lower than those in the control group (P<0.05).  Conclusion   Continuous lumbar plexus block can reduce pain and reduce inflammatory factor levels in patients undergoing hip arthroplasty after analgesia.It has less effect on patients’ cognitive function and can reduce complications

Key words: continuous lumbar plexus block, hip replacement, postoperative analgesia, application effect, visual simulated pain score, inflammatory factors, cognitive function

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