多模式镇痛效果及对下肢骨折患者免疫功能和细胞因子的影响

发布时间：2018-01-27 06:06

本文关键词： 多模式镇痛下肢骨折疼痛免疫功能细胞因子　出处：《苏州大学》2015年博士论文　论文类型：学位论文

【摘要】：目的:下肢骨折患者不仅承受骨折造成的痛苦,而且术后深受切口疼痛、患肢肿胀和限制活动等困扰。组织损伤、手术创伤、疼痛等导致细胞因子大量释放,在产生炎症反应的同时,也诱发中枢和外周疼痛敏化,加重疼痛,而且疼痛抑制机体的免疫功能,不利病情康复。科学、有效的镇痛能保护机体的免疫功能和抑制炎性反应,目前,多模式镇痛是临床普遍应用的镇痛模式,但尚无统一标准。因此,本研究探讨多模式镇痛对下肢骨折患者术后疼痛、免疫功能和细胞因子的影响,为临床镇痛提供参考。方法:100例ASAI~II级在腰硬联合麻醉下行下肢骨折切开复位内固定术患者,随机均分为对照组(C组,术前静脉注射生理盐水10ml,硬膜外腔注射生理盐水6ml,术毕静脉注射生理盐水10ml,硬膜外腔注射生理盐水6ml。)、多模式镇痛I组(MMA I组,术前静脉注射氟比洛芬酯100mg,硬膜外腔注射舒芬太尼0.3μg/kg,术毕静脉注射生理盐水10ml,硬膜外腔注射生理盐水6ml。)、多模式镇痛II组(MMA II组,术前静脉注射生理盐水10ml,硬膜外腔注射生理盐水6ml,术毕静脉注射氟比洛芬酯100mg,硬膜外腔注射舒芬太尼0.3μg/kg。)、多模式镇痛III组(MMA III组,术前静脉注射氟比洛芬酯50mg,硬膜外腔注射舒芬太尼0.15μg/kg,术毕静脉注射氟比洛芬酯50mg,硬膜外腔注射舒芬太尼0.15μg/kg。)。四组舒芬太尼均用生理盐水稀释至6ml,术后均行芬太尼自控静脉镇痛。记录术后6h、8h、12h、24h、48h VAS评分和术后24h芬太尼需要量、哌替啶需要次数,观察不良反应。比较术前、术后24h、48h CD4+、CD8+和CD4+/CD8+变化。记录术前、术后24h、48h白细胞介素-6(IL-6)和肿瘤坏死因子-a(TNF-α)浓度。结果:⑴术后12h、24h、48h VAS评分,MMA I组、MMA II组、MMA III组明显低于C组(P0.05);术后24h、48h VAS评分,MMA III组明显低于MMA I组、MMA II组(P0.05)。术后24h芬太尼需要量,MMA I组、MMA II组、MMA III组明显少于C组(P0.05),且MMA III组芬太尼需要量显著少于MMA I组、MMA II组(P0.05)。四组术后24h哌替啶需要次数和不良反应比较差异无统计学意义(P0.05)。⑵术前,MMA I组、MMA II组、MMA III组和C组CD4+、CD8+和CD4+/CD8+比较差异无统计学意义(P0.05);术后24h、48h,MMA I组、MMA II组、MMA III组CD4+和CD4+/CD8+明显高于C组(P0.05),而MMA III组显著高于MMA I组、MMA II组(P0.05)。⑶术前,MMA I组、MMA II组、MMA III组和C组IL-6和TNF-α浓度比较差异无统计学意义(P0.05);术后24h、48h,MMA I组、MMA II组、MMA III组IL-6和TNF-α浓度明显低于C组(P0.05),而MMA I组、MMA II组IL-6和TNF-α浓度显著高于MMA III组(P0.05)。结论:术前静脉注射氟比洛芬酯50mg+术前硬膜外腔注射舒芬太尼0.15μg/kg+术毕静脉注射氟比洛芬酯50mg+术毕硬膜外腔注射舒芬太尼0.15μg/kg,术后联合芬太尼自控静脉镇痛,这种多模式镇痛更能有效减轻下肢骨折患者的术后疼痛,改善免疫功能,减轻炎性反应。
[Abstract]:Objective: the patients with lower extremity fracture not only suffer from the pain caused by fracture, but also suffer from incision pain, swelling of the affected limb and restriction of movement. Tissue injury, surgical trauma, pain and so on lead to the release of cytokines. In the production of inflammatory reactions, but also induced central and peripheral pain sensitization, aggravated pain, and pain inhibits the immune function of the body, adverse to the recovery of the disease. Effective analgesia can protect the immune function and inhibit inflammatory response. At present, multi-mode analgesia is widely used in clinical analgesia, but there is no unified standard. This study was designed to investigate the effects of multimode analgesia on postoperative pain, immune function and cytokines in patients with lower extremity fracture. Methods one hundred ASAI~II patients with lower extremity fracture treated by open reduction and internal fixation under spinal-epidural anesthesia were randomly divided into control group (group C) and control group (group C). Before operation, 10 ml of saline was injected intravenously, 6 ml of saline was injected into epidural cavity, 10 ml of saline was injected intravenously after operation, and 6 ml of saline was injected into epidural cavity. Before operation, flurbiprofen ester 100mg was injected intravenously, sufentanil 0.3 渭 g / kg was injected into epidural cavity, and normal saline 10ml was injected intravenously at the end of operation. 6 ml saline was injected into epidural cavity, and 10 ml saline was injected intravenously before operation in MMA II group, and 6 ml saline was injected into epidural cavity. After operation, flurbiprofen ester 100mg was injected intravenously, and sufentanil 0.3 渭 g / kg 路L 路L 路L 路L was injected into epidural cavity. The multimode analgesia III group was treated with MMA III. Before operation, flurbiprofen ester 50 mg, sufentanil 0.15 渭 g / kg, flurbiprofen 50 mg respectively. Sufentanil was injected into epidural cavity with 0.15 渭 g 路kg 路L sufentanil. Sufentanil was diluted to 6 ml with normal saline in all the four groups. Postoperative patient-controlled intravenous analgesia was performed with fentanyl. The adverse reactions were observed at 24 h, 48 h VAS score, 24 h fentanyl requirement, and 24 h pethidine requirement, and the adverse reactions were compared before and 24 h after operation for 48 h. The changes of CD8 and CD4 / CD8 were recorded before and 24 hours after operation. Results the concentration of interleukin-6 (IL-6) and TNF- 伪 (TNF- 伪) were measured at 48 h. Results the VAS scores were assessed at 24 h and 48 h after 1: 1 operation in MMAI group. MMA III in MMA II group was significantly lower than that in C group (P 0.05). The VAS score was significantly lower in the MMA III group than in the MMA I group at 24 and 48 hours after operation (P 0.05), and the fentanyl requirement at 24 hours after operation was significantly lower in the MMA III group than in the MMA I group. The content of fentanyl in group MMA II was significantly lower than that in group C (P 0.05), and the fentanyl requirement in group MMA III was significantly lower than that in group MMA I. There was no significant difference in the number of pethidine needs and adverse reactions between the four groups 24 hours after operation. There was no significant difference in CD4 CD8 and CD4 / CD8 between MMA III group and C group in MMA II group (P 0.05). CD4 and CD4 / CD8 in MMA III group were significantly higher than those in C group (P 0.05). However, MMA III group was significantly higher than MMA I group (P 0.05). There was no significant difference in the concentration of IL-6 and TNF- 伪 between MMA III group and C group (P 0.05). The concentrations of IL-6 and TNF- 伪 in MMA III group were significantly lower than those in C group (P 0.05) and MMA I group (P < 0.05). The concentrations of IL-6 and TNF- 伪 in MMA II group were significantly higher than those in MMA III group (P 0.05). Conclusion: 50 mg flurbiprofen ester was injected intravenously before operation by epidural injection of sufentanil 0.15 渭 g / kg, 50 mg flurbiprofen ester was injected intravenously after operation. At the end of operation, sufentanil was injected into epidural cavity with 0.15 渭 g / kg sufentanil. Postoperative patient-controlled intravenous analgesia combined with fentanyl, this multi-mode analgesia can effectively relieve postoperative pain, improve immune function and alleviate inflammatory reaction in patients with lower extremity fracture.
【学位授予单位】：苏州大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R614

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