摘要
目的探讨全身麻醉下钠钾镁钙注射液联合6%羟乙基淀粉液进行高容量血液稀释对下肢骨折患者免疫炎性反应的影响。方法选择全麻下下肢骨折手术患者160例,随机分为两组。对照组给予全身麻醉。观察组围手术期给予输注钠钾镁钙注射液联合6%羟乙基淀粉液进行高容量血液稀释。手术前后检测血清TNF-α、IL-6、PCT、血浆D-Dimer、血浆Fib与外周血CD4+、CD4+CD25+调节性T细胞水平,比较两组患者术后疼痛程度评分、术后感染、深静脉血栓形成率、患者肿胀程度差异。结果与治疗前比较,两组患者血清IL-6、TNF-α、PCT、血浆D-Dimer、CD4+CD25+调节性T细胞水平均下降,血浆Fib、CD4+T淋巴细胞比例升高(P<0.05)。其中,观察组改善幅度优于对照组(P<0.05)。观察组患者术后感染、疼痛评分、深静脉血栓形成率、患肢肿胀程度明显低于对照组,两组比较差异有统计学意义(P<0.05)。两组患者心肌损伤、射血分数与急性肾损伤发生比例未见明显差异(P>0.05)。结论全身麻醉下钠钾镁钙注射液联合6%羟乙基淀粉液进行高容量血液稀释可以调节下肢骨折患者术后炎性反应,调节免疫平衡,降低术后疼痛程度,保护血管内皮损伤,对心肾等重要脏器功能负荷无明显影响。
Objective To investigate the effect of high-volume hemodilution of sodium potassium magnesium-magnesium sulfate combined with 6% hydroxyethyl starch solution under general anesthesia on the immunoinflammatory response in patients with lower limb fracture. Methods A total of 160 patients with lower extremity fractures under general anesthesia were randomly divided into two groups. The control group was given general anesthesia. The observation group was given the infusion of sodium potassium magnesium phosphate injection combined with 6% hydroxyethyl starch solution for high volume hemodilution in the perioperative period. Before and after surgery, serum TNF-α, IL-6, PCT, plasma D-Dimer, plasma Fib and CD4+, CD4+CD25+ regulatory T cells in peripheral blood were measured. The postoperative pain scores, postoperative infection, deep vein thrombosis rate, and the degree of swelling in patients of two groups were compared. Results Compared with those before treatment, the levels of serum IL-6, TNF-α, PCT, plasma D-Dimer, CD4+CD25+ regulatory T cells decreased, and the proportion of plasma Fib and CD4+ T lymphocytes increased after treatment in two groups(P<0.05). Among them, the improvement rate of the observation group was better than that of the control group(P<0.05). The postoperative infection, pain score, deep vein thrombosis rate and swelling of the affected limb were significantly lower in the observation group than those in the control group. The difference between the two groups was statistically significant(P<0.05). There was no significant difference in the ratio of myocardial injury, ejection fraction and acute kidney injury between the two groups (P>0.05). Conclusion High-volume hemodilution with sodium potassium magnesium-magnesium sulfate combined with 6% hydroxyethyl starch solution under general anesthesia can regulate the postoperative inflammatory response level, regulate immune balance, reduce postoperative pain and protect vascular endothelial injury. It has no significant effect on the function
作者
程祥庆
CHENG Xiangqing(Department of Anesthesiology, Weifang Traditional Chinese Medicine Hospital in Shandong Province, Weifang 261000, China)
出处
《中国现代医生》
2019年第15期98-101,共4页
China Modern Doctor
关键词
骨折
麻醉
高容量血液稀释
细胞免疫
炎性反应
Fracture
Anesthesia
High volume hemodilution
Cellular immunity
Inflammatory response
