摘要
目的探讨连续股神经-坐骨神经阻滞和连续股神经-关节腔鸡尾酒阻滞之间的镇痛效果。方法 60例拟实施单膝关节置换术(TKA)的患者,分为连续股神经-坐骨神经组(S组,n=30)与连续股神经-关节腔鸡尾酒组(C组,n=30)。用ELISA法检测不同时间点白介素-6(IL-6)、肿瘤坏死因子(TNF-a)、C-反应蛋白(CRP)、P物质(PS)浓度,并记录患者术后72 h内静息、运动下VAS评分及术后不良反应。结果患者术后24、48 h静息和运动状态下VAS评分C组明显低于S组(P<0.05),且术后72 h VAS评分2组间差异无统计学意义(P>0.05)。术后12 h患肢运动功能S组明显差于C组(P<0.05),其他时间2组间差异无统计学意义。2组患者IL-6、C-RP、SP、TNF-a术后均有不同程度升高,S组升高更明显且在术后24、72 h时差异有统计学意义(P<0.05)。结论连续股神经-关节腔鸡尾酒阻滞镇痛对TKA镇痛效果以及降低术后炎症反应优于连续股神经-坐骨神经阻滞。
Objective To study the analgesic effect of femoral nerve block combined with sciatic nerve block and femoral nerve block combined with cocktail articular cavity injection from the angle of inflammatory factors. Methods 60 patients separated by TKA were randomly divided into two groups ： Femoral Nerve Block combined with Sciatic Nerve Block group （ Group S, n = 30） and Femoral Nerve Block combined with Cocktail Block group （Group C, n = 30 ）. Blood samples were collected before anesthesia （T0） ,when from a series of time points：a tourniquet（T1 ）, the tourniquet release （T2） ,24 hours after surgery （T3 ） ,72 hours after the operation （T4 ）, the serum interleukin -6 and tumor necrosis factor TNF - u, C - Reactive Protein , substance P concentration were measured by ELISA ac- cording to manufacturer＇ s instructions, and were recorded within 72hours of rest and motion state of VAS score and postoperative adverse reactions occurred. Results The VAS of patients in resting states at 24,48 hours and in movement state at 24,48 hours after surgery were significantly lower in Group C than in Group S （P 〈 0.05）. There was no significant difference in the VAS at 72 hours after surgery （P 〉 0.05 ）. The motor function of lower limb has significance between the group S than group C at 12 hours after surgery. There were no significant difference with regards to the lower limb motor function between the two groups at other time - point. There was no serious adverse reactions in two groups. The concentration of IL - 6, TN, CRP and SP increased at loosen tourniquet, it is more significently dif- ferent in 24 and 72 hours after surgery in S group. Conclusion Effect of Femoral Nerve Block combined with Cocktail Articular Cavity Injection relieved pain and inhibited clinical inflammation after total knee arthroplasty was better than Femoral Nerve Block combined with Femoral Sciatic Nerve Block.
作者
于芝
焦华杰
叶青山
海克蓉
徐卉芳
YU Zhi;JIAO Huajie;YE Qingshan;HAI Kerong;XU Huifang(Anesthesiology Department, Ningxia People＇ s Hospital, Yin- chuan 750002, China;The First Clinical College of Northwest University for Nationalities, Yinchuan 750002, China)
出处
《宁夏医学杂志》
CAS
2018年第4期310-313,共4页
Ningxia Medical Journal
基金
宁夏自然科学基金资助项目( NZ15188)
