不同麻醉方法对单膝关节置换术患者围术期应激反应的影响

Effects of different anesthesia methods on perioperative stress in patients undergoing unilateral total knee arthroplasty

目的探讨不同麻醉方式对单膝关节置换术患者围术期应激反应的影响。方法选取解放军总医院2014年单膝关节置换手术患者,根据麻醉方法分为全身麻醉(general anesthesia,GA)组204例、单纯神经阻滞(nerve block,NB)组44例和椎管内麻醉(epidural anesthesia,EA)组49例,比较3组术前(T0)、术后1 d(T1)、术后3 d(T2)及术后5 d(T3)外周血炎性因子C反应蛋白(C reactive protein,CRP)及白细胞介素-6(interleukin-6,IL-6)浓度,以及术后发热、伤口感染、关节腔积液和深静脉血栓的发生情况。结果 3组患者性别构成、年龄、身高、体质量、手术时间等差异均无统计学意义(P>0.05)。3组患者CRP在术后第3天达高峰,与同组术前比较差异均有统计学意义(P<0.05);与GA组相比,NB组CRP水平(6.3±2.0)mg/L明显高于GA组的(5.8±3.4)mg/L(P<0.05)。3组IL-6在术后第1天均出现明显升高,与同组术前比较差异有统计学意义(P<0.05);与GA组相比,NB组IL-6水平(52.7±31.0)ng/L明显高于GA组的(40.6±38.9)ng/L(P<0.05)。3组术后并发症发生率差异无统计学意义。结论所有单膝关节置换术患者术后当日均可见炎性因子升高,与单纯椎管内麻醉组和单纯神经阻滞麻醉组相比,全麻组围术期应激反应较轻,是单膝关节置换术患者较为理想的麻醉方法。

Objective To investigate the effects of three different anesthesia methods on perioperative stress in patients undergoing unilateral total knee arthroplasty（UTKA）. Methods Medical records of patients admitted for UTKA in our hospital from January to December in 2014 were analyzed. Patients were divided into three groups： general anesthesia（GA） group（n=204）, nerve block（NB） group（n=44） and epidural anesthesia（EA） group（n=49）, and their gender, age, height, weight and the duration of operation in three groups were recorded. The level of serum C reactive protein（CRP） and interleukin-6（IL-6） was measured at preoperative（T0） and 1, 3 and 5 days after operation（T1, T2, T3）. At the same time, the occurrence of fever, wound infection, joint effusion and deep venous thrombosis were recorded. Results There was no significant difference in gender composition, age, height, weight, and operation time between three groups（P 〉0.05）. From the time point of view, CRP reached peak at the third day after surgery and IL-6 began to rise at the first day after surgery of patients in three groups with significant differences when compared with before treatment（P 〈0.05）. Compared with GA group, the serum CRP and IL-6 in NB group was significantly higher [（6.3±2.0） mg/L vs（5.8±3.4） mg/L;（52.7±31.0） ng/L vs（40.6±38.9） ng/L, P 〈0.05]. There was no significant difference in postoperative complications between three groups（P 〉0.05）. Conclusion The inflammatory factors increase in all patients with UTKA on the first day after surgery. Compared with simple EA and NB, general anesthesia can obviously reduce the stress reaction of patients, which suggests that it is a suitable method for patients with UTKA.