全身麻醉复合神经阻滞对行全膝关节置换术患者外周血T淋巴细胞亚群细胞因子的影响

Effect of general anesthesia combined with nerve block on peripheral blood tlymphocyte subsets cytokines in patients with total knee arthroplasty

目的探讨全身麻醉复合神经阻滞对行全膝关节置换术患者外周血T淋巴亚群细胞因子的影响.方法选取骨关节炎择期行全膝关节置换术患者60例,美国麻醉医师协会（ASA）n级,年龄65-80岁,体质量45-80kg.采用随机数字表法将其分为2组（n=30）：G组为全身麻醉组;N组为全身麻醉复合超声定位下以0.5%罗哌卡因行转子下坐骨神经和股神经阻滞组.两组患者术后均行患者自控静脉镇痛（PCIA）.观察术中心电图（ECG）、脉搏氧饱和度（SPO2）、呼气末二氧化碳分压（PETCO2）,两组患者麻醉诱导前（T0）、术毕（T1）、术后24h（T2）、72h（T3）各个时点抽取外周静脉血,ELISA测量1型辅助性T细胞（Th1）、Th2、Th17、调节性T细胞（Treg）肿瘤坏死因子（TNF-α、白细胞介素4（IL-4）、白细胞介素17（IL-17）、转化生长因子β（TGF-β）的浓度.记录术后T2、T3时疼痛VAS评分.结果与G组比较,T1-3时N组血浆中促炎因子TNF-α、IL-17浓度明显降低（P〈0.05）,抑炎因子IL-4、TGF-β显著升高（P〈0.05）.T2时N组疼痛VAS评分明显降低（P〈0.05）.无神经阻滞并发症发生.结论全膝关节置换手术应用全身麻醉复合超声引导转子下坐骨神经及股神经阻滞能平衡T淋巴亚群细胞因子浓度,减轻炎症损伤.

Objective To explore the effects of general anesthesia combined with nerve block on peripheral blood T lymphocyte subsets cytokines in patients with total knee arthroplasty （ TKA ）. Methods Select 60 cases of patients with osteoarthritis undergoing TKA whose ages were 65 - 80, weight were 45 - 80 kg with ASA physical status of patients were Ⅱ or Ⅲ. All patients were divided into two groups （ n = 3 0 ） by random number tables ： group G received general anesthesia, group N received general anesthesia combined with 0.5% ropivacaine femoral and sciatic nerve block guided by ultrasound. Patients of two groups were patient-controlled intravenous analgesia （ PCIA） after TKA. Blood was taken at different time points including： before anesthesia （T0） ,end of operation （T2） ,24 h and 72 h after the surgery（ T2 3 ） . Concentration of type 1 helper T cell （ Th1 ） ,Th2,Th17, regulatory T cells （ Treg） cytokine TNF-α （Th1） （Th2） ,IL-17 （Thl7） ,TGF-β （Treg） was measured by ELISA. Results Compared with group G,pro-inflammatory cytokines TNF-α,IL-17was significantly reduced （P 〈0. 05） , suppressive inflammatory cytokines IL4, TGF-β was increased significantly （ P 〈 0. 05 ） in group N at T13. Nerve blocking complications were not found in both groups. Conclusion General anesthesia combined with nerve block guided by ultrasound can balance the Tlymphocyte subsets factor concentration cells and reduce inflammation in patients with TKA.