安徽医药
安徽醫藥
안휘의약
ANHUI MEDICAL AND PHARMACEUTICAL JOURNAL
2015年
5期
974-977
,共4页
多模式镇痛%下肢骨折%疼痛%炎性因子
多模式鎮痛%下肢骨摺%疼痛%炎性因子
다모식진통%하지골절%동통%염성인자
multi-modal analgesia%lower limb fractures%pain%inflammatory cytokines
目的：探讨多模式镇痛（MMA）对下肢骨折患者术后疼痛和炎性因子的影响。方法120例下肢骨折患者，随机均分为对照组（C组）、MMA Ⅰ组、MMA Ⅱ组、MMA Ⅲ组。C组不给镇痛，Ⅰ组仅术前给予氟比洛芬酯（经静脉）和舒芬太尼（经硬膜外），Ⅱ组术后给药，Ⅲ组术前和术后均给药。记录术后6、12、24 h VAS评分和术前、术后24、72 h白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平和外周血CD4＋／CD8＋、CD25＋比例、NK细胞（CD3－CD16＋CD56＋）比例。结果 MMA Ⅰ组、MMA Ⅱ组、MMAⅢ组术后12、24 h VAS评分明显低于C组（P＜0．05）；MMA Ⅲ组术后24 h VAS评分显著低于MMA Ⅰ组、MMA Ⅱ组（P＜0．05）。MMAⅠ组、MMAⅡ组、MMAⅢ组术后24、72 h IL-6和TNF-α浓度明显低于C组（P＜0．05），MMAⅠ组、MMA Ⅱ组显著高于MMA Ⅲ组（P＜0．05）；术后24、72 h MMAⅠ组、MMA Ⅱ组、MMA Ⅲ组IL-6和TNF-α浓度明显高于C组（P＜0．05）；MMA Ⅰ组和MMA Ⅲ组CD4＋／CD8＋术后72 h恢复到术前水平（P＞0．05）。MMA Ⅲ组NK细胞术后72 h恢复到术前水平，无统计学差异（P＞0．05）。术后24 h血清IL-6、TNF-α水平和外周血CD4＋／CD8＋、NK细胞水平均呈负相关关系（P＜0．05）。而术后72 h血清炎性因子和外周免疫细胞相关性不明显。结论 MMA有效改善下肢骨折患者术后疼痛，减轻炎性反应。
目的：探討多模式鎮痛（MMA）對下肢骨摺患者術後疼痛和炎性因子的影響。方法120例下肢骨摺患者，隨機均分為對照組（C組）、MMA Ⅰ組、MMA Ⅱ組、MMA Ⅲ組。C組不給鎮痛，Ⅰ組僅術前給予氟比洛芬酯（經靜脈）和舒芬太尼（經硬膜外），Ⅱ組術後給藥，Ⅲ組術前和術後均給藥。記錄術後6、12、24 h VAS評分和術前、術後24、72 h白細胞介素-6（IL-6）、腫瘤壞死因子-α（TNF-α）水平和外週血CD4＋／CD8＋、CD25＋比例、NK細胞（CD3－CD16＋CD56＋）比例。結果 MMA Ⅰ組、MMA Ⅱ組、MMAⅢ組術後12、24 h VAS評分明顯低于C組（P＜0．05）；MMA Ⅲ組術後24 h VAS評分顯著低于MMA Ⅰ組、MMA Ⅱ組（P＜0．05）。MMAⅠ組、MMAⅡ組、MMAⅢ組術後24、72 h IL-6和TNF-α濃度明顯低于C組（P＜0．05），MMAⅠ組、MMA Ⅱ組顯著高于MMA Ⅲ組（P＜0．05）；術後24、72 h MMAⅠ組、MMA Ⅱ組、MMA Ⅲ組IL-6和TNF-α濃度明顯高于C組（P＜0．05）；MMA Ⅰ組和MMA Ⅲ組CD4＋／CD8＋術後72 h恢複到術前水平（P＞0．05）。MMA Ⅲ組NK細胞術後72 h恢複到術前水平，無統計學差異（P＞0．05）。術後24 h血清IL-6、TNF-α水平和外週血CD4＋／CD8＋、NK細胞水平均呈負相關關繫（P＜0．05）。而術後72 h血清炎性因子和外週免疫細胞相關性不明顯。結論 MMA有效改善下肢骨摺患者術後疼痛，減輕炎性反應。
목적：탐토다모식진통（MMA）대하지골절환자술후동통화염성인자적영향。방법120례하지골절환자，수궤균분위대조조（C조）、MMA Ⅰ조、MMA Ⅱ조、MMA Ⅲ조。C조불급진통，Ⅰ조부술전급여불비락분지（경정맥）화서분태니（경경막외），Ⅱ조술후급약，Ⅲ조술전화술후균급약。기록술후6、12、24 h VAS평분화술전、술후24、72 h백세포개소-6（IL-6）、종류배사인자-α（TNF-α）수평화외주혈CD4＋／CD8＋、CD25＋비례、NK세포（CD3－CD16＋CD56＋）비례。결과 MMA Ⅰ조、MMA Ⅱ조、MMAⅢ조술후12、24 h VAS평분명현저우C조（P＜0．05）；MMA Ⅲ조술후24 h VAS평분현저저우MMA Ⅰ조、MMA Ⅱ조（P＜0．05）。MMAⅠ조、MMAⅡ조、MMAⅢ조술후24、72 h IL-6화TNF-α농도명현저우C조（P＜0．05），MMAⅠ조、MMA Ⅱ조현저고우MMA Ⅲ조（P＜0．05）；술후24、72 h MMAⅠ조、MMA Ⅱ조、MMA Ⅲ조IL-6화TNF-α농도명현고우C조（P＜0．05）；MMA Ⅰ조화MMA Ⅲ조CD4＋／CD8＋술후72 h회복도술전수평（P＞0．05）。MMA Ⅲ조NK세포술후72 h회복도술전수평，무통계학차이（P＞0．05）。술후24 h혈청IL-6、TNF-α수평화외주혈CD4＋／CD8＋、NK세포수평균정부상관관계（P＜0．05）。이술후72 h혈청염성인자화외주면역세포상관성불명현。결론 MMA유효개선하지골절환자술후동통，감경염성반응。
Objective To investigate the influence of multi-modal analgesia on postoperative pain and inflammatory cytokines in pa-tients with lower limb fractures.Methods 120 patients with lower limb fractures were randomly divided into control group (group C), MMA Ⅰgroup,MMA Ⅱgroup,and MMAⅢgroup.Group C didn’t receive analgesia;group I received analgesia using lurbiprofen ax-etil (intravenous)and sufentanil (through epidural)preoperatively;MMA Ⅱ received analgesia postoperatively;MMA Ⅲgroup re-ceived both preoperatively and postoperatively.VAS scores were recorded at 6,12,and 24 h after surgery,and the concentrations of in-terleukin-6 (IL-6)and tumor necrosis factor-α(TNF-α)were also recorded at postoperative 24 h and72 h.Results VAS scores at postoperative 12 h and24 h in groups MMA Ⅰ,MMA Ⅱ and MMA Ⅲwere significantly lower than those in group C (P <0.05);VAS scores at postoperative 24h in group MMA Ⅲwere significantly lower than that in groups MMA Ⅰand MMA Ⅱ(P <0.05).The concentrations of IL-6 and TNF-αat postoperative 24 and 72 h in groups MMAⅠ,MMAⅡand MMAⅢ were significantly lower than those in group C (P <0.05),and the concentrations of IL-6 and TNF-αat postoperative 72h in groups MMA Ⅰ and MMA Ⅱ were significantly higher than those in group MMA Ⅲ(P <0.05).CD4 +/CD8 +in MMAⅠ and MMAⅢ groups recovered to preoperative levels in 72h (P>0.05).NK cells in MMAⅢgroup recovered to preoperative levels in 72h (P>0.05).There was negative correlation among IL-6,TNF-α,CD4 +/CD8 +and NK cells(P <0.05)24h after the surger-y,but there was not obvious correlation among them 72h after the surgery.Conclusions Multi-modal analgesia effectively im-proved postoperative pain and reduced inflammation in patients with lower limb fracture.
