超前镇痛联合多模式镇痛在创伤骨科应用临床疗效及对炎性因子表达影响

Effect of preemptive analgesia combined multimodal analgesia in orthopaedic traumatic patients

目的探讨超前镇痛联合多模式镇痛在创伤骨科应用临床疗效及对炎性因子的影响。方法选择90例我院收治的骨与关节损伤需要手术患者,分A、B、C共3组,每组病例30例。A组(常规模式镇痛组)、B组(超前镇痛联合多模式镇痛组)、C组(多模式镇痛组)。观察术前、术后血浆中炎性因子指标,术后镇痛效果、镇痛药物不良反应。结果B组患者术后1 h、24h、、48 h、72 h的疼痛评分均明显低于A组和C组(P<0.05);B组患者不良反应发生率均明显低于A组和C组(P<0.05)。A组和C组患者术后1 h、24 h、48 h CPR水平明显高于术前;B组患者术后1 h、24 h CPR水平明显高于术前;B组患者术后24 h、术后48 h CPR水平明显低于A组和C组(所有P<0.05)。三组术后1 h、24 h、48 h的Cor水平明显高于术前;B组和C组患者术后1h、24 h、48 h Cor水平明显低于A组;B组患者术后24 h、术后48 h Cor水平明显低于A组和C组(所有P<0.05)。三组术后24 h、48 h的IL-6水平明显高于术前(P<0.05),其中,B组和C组术后24 h、48 h明显低于A组,B组低于C组。B组患者术后1 h、2 4h、48 h IL-10水平明显低于术前及A组和C组治疗后(P<0.05)。结论超前镇痛联合多模式镇痛在创伤骨科应用临床疗效好,抗炎效果显著。

Objective To investigate the clinical curative effect of preemptive analgesia combined multimodal analgesia on orthopaedic traumatic patients and the influence on serum level of inflammatory factors. Methods Ninety patients with bone and joint injury in our hospital were treated by surgery under combined spinal epidural anesthesia. According to the random number of the computer, the patients were divided into three groups, A group（conventional analgesia group,n=30）,group B（preemptive analgesia combined multimodal analgesia group,n =30） and group C（multimodal group,n =30）. Serum levels of inflammatory factors in the patients before and after operation,analgesic effect and adverse drug reactions were observed and analyzed. Results In group B, pain scores in 1 h after operation, 24 h, 48 h, 72 h were significantly lower than that of group A and group C, and the differences were statistically significant. Incidence of adverse reactions in B group were obviously lower than that in group A and group C（P〈0.05）. CPR level in postoperative 1 h, 24 h, 48 h in group A and group C were obviously higher than that of preoperative（P〈0.05）. CPR level of postoperative 24 h, 48 h in group B was lower than that in group A and group C（P〈0.05）.HCPR level of postoperative 1 h, 24 h in group B were significantly higher than those of preoperative level（P〈0.05）. Cor levels in three groups were significantly higher than the preoperative Cor levels,and which of group B and C were significantly higher than that of group A. Postoperative IL-6 levels in three groups were increased than the preoperative（P〈0.05） and which in group B and C was lower than that in group A in postoperative 24 h, 48 h. IL-6 level in Group B in postoperative 24 h, 48 h were lower than that in group A and group C（P〈0.05）. The levels of IL-10 in group B in 1 h, 24 h, 48 h were lower than in geoup A and C. Conclusion Preemptive analgesia combined multimodal analgesia showed good clinical curative effect in orthopaedic traumatic patients.