摘要
目的 :分析不同麻醉方式对膝关节置换术患者凝血功能及血清皮质醇(Cor)、P物质(SP)及炎症因子水平的影响。方法 :选取2016年2月~2018年2月我院行膝关节置换术患者80例为研究对象,采用随机数字表法将其分为观察组、对照组各40例,对照组采取全身麻醉,观察组采取连续股神经阻滞复合局部浸润麻醉,比较两组一般情况、凝血功能[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)]、血清Cor、SP及炎症因子[超敏-C反应蛋白(hs-CRP)、白介素-6(IL-6)]水平、术后72h内疼痛视觉模拟评分(VAS)及不良反应。结果 :两组手术时间、失血量比较差异无统计学意义,观察组麻醉起效时间、麻醉药剂量、自主呼吸恢复时间短/少于对照组;观察组术后APTT、PT、FIB长/高于对照组;观察组麻醉后血清Cor、SP及hs-CRP、IL-6水平明显低于对照组;观察组术后24h、48h、72h VAS评分低于对照组;观察组不良反应发生率2.50%低于对照组15.00%。结论 :与全身麻醉相比,连续股神经阻滞复合局部浸润麻醉起效快、镇痛效果显著,且对凝血功能影响小,可有效减少苏醒期应激反应、炎症反应,降低不良反应发生率,值得在临床推广实践。
Objective To analyze the effect of different anesthesia methods on coagulation function and levels of serum cortisol(Cor),substance P(SP)and inflammatory factors in patients undergoing knee replacement.Methods 80 patients undergoing knee replacement in the hospital from February 2016 to February 2018 were selected as subjects.They were divided into observation group and control group by random number table method,40 patients in each group.The control group were given general anesthesia and the observation group were given continuous femoral nerve block combined with local infiltration anesthesia.The general conditions,coagulation function[activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen(FIB)],levels of serum Cor,SP and inflammatory factors[high sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6)],pain visual analogue scale(VAS)score and adverse reactions within 72 hours after surgery were compared between the two groups.Results There was no significant difference in the surgical time or blood loss between the two groups.The an-esthesia onset time,dose of anesthetic and spontaneous respiratory recovery time in the observation group were shorter/less than those in the control group.The APTT,PT and FIB in the observation group after surgery were longer/higher than those in the control group.Levels of serum Cor,SP,hs-CRP and IL-6 in the observation group were significantly lower than those in the control group.VAS scores at 24 h,48 h and 72 h after surgery were lower than those in the control group.The incidence of adverse reactions in the observation group was lower than that in the control group(2.50%vs 15.00%).Conclusion Compared with general anesthesia,continuous femoral nerve block combined with local infiltration anesthesia can work fast,with significant analgesic effect.It has little effect on coagulation function,and can effectively reduce the stress response and inflammatory response during recovery and decrease the incidence of adverse reactions.
作者
魏海强
李亮
刘娜
Wei Hai-qiang;Li Liang;Liu Na(Department of Arthrology,Second Hospital of Tangshan City,Tangshan 063000,China)
出处
《湖南师范大学学报（医学版）》
2019年第3期102-105,共4页
Journal of Hunan Normal University(Medical Sciences)
