CAJ | 학술논문

目的：研究等效视觉模拟评分下静脉自控镇痛（PCIA）及硬膜外自控镇痛（PCEA）对老年患者髋关节置换术（包括全髋关节及半髋关节，且人工髋关节的假体均为非骨水泥型关节）后血清炎性因子表达水平的影响。方法：选择髋关节置换术后老年患者（年龄＞60岁），根据接受PCIA和PCEA随机分为两组，术后12 h进行视觉模拟评分（VAS）评价镇痛效果，评分≤2的患者纳入本次研究，每组30例。各组随机抽取15例，在术后12 h 留取血液标本，分别采用ELISA、RT-PCR 及 Western blot 方法检测患者血清炎性因子的mRNA 及蛋白表达水平。结果：PCEA 组患者血清 TNF-α和 IL-6的 mRNA 及蛋白表达水平低于 PCIA 组（P ＜0．05），IL-10的mRNA及蛋白表达水平高于PCIA组（P ＜0．05）；TGb-β血清蛋白表达水平高于PCIA组（P ＜0．05）；两组间IL-8 mRNA及蛋白表达水平差异无统计学意义（P ＞0．05）。结论：PCEA较PCIA可以更好地促进抗炎因子表达，抑制促炎因子表达，维护炎性因子平衡。
목적：연구등효시각모의평분하정맥자공진통（PCIA）급경막외자공진통（PCEA）대노년환자관관절치환술（포괄전관관절급반관관절，차인공관관절적가체균위비골수니형관절）후혈청염성인자표체수평적영향。방법：선택관관절치환술후노년환자（년령＞60세），근거접수PCIA화PCEA수궤분위량조，술후12 h진행시각모의평분（VAS）평개진통효과，평분≤2적환자납입본차연구，매조30례。각조수궤추취15례，재술후12 h 류취혈액표본，분별채용ELISA、RT-PCR 급 Western blot 방법검측환자혈청염성인자적mRNA 급단백표체수평。결과：PCEA 조환자혈청 TNF-α화 IL-6적 mRNA 급단백표체수평저우 PCIA 조（P ＜0．05），IL-10적mRNA급단백표체수평고우PCIA조（P ＜0．05）；TGb-β혈청단백표체수평고우PCIA조（P ＜0．05）；량조간IL-8 mRNA급단백표체수평차이무통계학의의（P ＞0．05）。결론：PCEA교PCIA가이경호지촉진항염인자표체，억제촉염인자표체，유호염성인자평형。
Objective To evaluate influence of patient-controlled intravenous analgesia (PCIA) and patient-controlled epidural analgesia (PCEA) on expressions of serum inflammatory cytokines in elderly patients with hemi or whole hip replacement using cemented artificial joint. Methods Elderly patients undergoing hip replacement were selected and were divided into PCIA group and PCEA group. VAS scores were calculated at 12 h postoperatively. Patients whose VAS scores were not more than 2 at postoperative 12h were included. 30 cases in each group were finally included. Fifteen cases were randomly chosen in each group and underwent sample blood drawing for assays. Expressions of serum inflammatory cytokines were detected by ELISA , RT-PCR and Western-blot. Results Gene and protein expressions of TNF-a as well as IL-6 in group PCEA were lower and expression of IL-10 was higher than that in group PCIA. Serum level of TGb-β was higher in group PCEA detected by ELISA. There was no significant difference in expression of IL-8 between groups. Conclusions PCEA may better promote expressions of anti-inflammatory cytokines and inhibit expressions of proinflammatory cytokines. PCEA is superior in maintenance of inflammatory cytokine balance.