关节镜下膝关节韧带重建术后针灸联合静脉镇痛的应用及对IL-6和IL-8水平的影响

Application of Acupuncture Combined with Intravenous Analgesia and Its Effect on the Levels of IL-6 and IL-8 in Arthroscopic Reconstruction of Knee Joint Ligament

目的:分析研究关节镜下膝关节韧带重建术后针灸联合静脉镇痛的应用及对IL-6和IL-8水平的影响。方法:随机选取本院92例关节镜下膝关节韧带重建术患者进行研究,采用随机数字表法分组,静脉组患者(n=46)术后采用静脉镇痛泵镇痛,联合组患者(n=46)术后采用静脉镇痛泵配合针灸疗法镇痛,必要时静脉注射曲马多,采用VAS评分法对患者术后2 h、术后6 h、术后12 h、术后24 h的疼痛情况进行评估,测定患者术前、术后24 h的IL-6、IL-8、TNF-α水平变化,统计术后48 h曲马多用量,随访术后3个月KSS评分、最大屈曲度、最大伸直度,并对治疗中出现的不良反应进行统计。结果:术后2 h两组患者VAS评分比较无明显差异(P>0.05),术后6 h、术后12 h、术后24 h两组患者VAS评分逐渐降低,联合组患者为(2.11±0.51)分、(1.82±0.42)分、(1.44±0.41)分,明显低于静脉组患者的(2.64±0.54)分、(2.21±0.47)分、(1.90±0.47)分,差异有统计学意义(P<0.05)。术前两组患者的IL-6、IL-8、TNF-α水平比较差异无统计学意义(P>0.05)。术后24 h两组患者IL-6、IL-8、TNF-α水平均明显升高,联合组患者IL-6、IL-8、TNF-α水平均明显低于对照组患者,差异有统计学意义(P<0.05)。静脉组患者术后48 h曲马多用量为(22.4±4.2)mg,联合组患者为(15.2±3.5)mg,联合组用量明显低于静脉组(P<0.05)。两组患者治疗后3个月膝关节功能对比,KSS评分、最大屈曲度、最大伸直度比较差异不明显(P>0.05),治疗中均有少量头晕、头痛等不良反应发生,对症治疗后好转,组间无差异(P>0.05)。结论:关节镜下膝关节韧带重建术后针灸联合静脉镇痛的镇痛效果明显,患者炎症情况明显好转,且膝关节功能明显好转,安全性高。

Objective .To analyze the application of acupuncture combined with intravenous analgesia and its effect on the levels of IL - 6 and IL - 8 in arthroscopic reconstruction of knee joint ligament. Methods： Randomly select 92 cases of arthroscopic knee ligament＇ reconstruction in our hospital and they were grouped by random number table method. Patients （n = 46） in the venous group were treated with intravenous analgesia pump, and the combination group was treated with intravenous analgesia combined with acupuncture （ n = 46 ）, with intramuscular injection of morphine analgesia when necessary. The VAS scores of patients after 2 h, 6 h, 2 h,24 h were evaluated. Determine patients before operation, postoperation 24 h according to IL - 6, IL - 8, TNF - α,the amount of statistics after 48 h of morphine, follow - up of KSS score after 3 months, maximum flexion, maximum extension degree and adverse reactions. Results：There was no significant difference in VAS scores between two groups after operation of 2 hours （P 〉 0.05 ） , and as to the postoperation 6 h, postoperation 12 h, postoperation 24 h in two groups VAS scores gradually decreased, and in the combination group VAS scores were （2.11± 0. 51 ） points, （ 1.82 ± 0.42 ） points, （ 1.44 ± 0.41 ） points, which were significantly lower than （ 2.64 ± 0.54 ） points, （2.21 ± 0. 47 ） points and （ 1.90 ± 0.47 ） points, and the difference was statistically significant （ P 〈 0.05 ）. There was no significant difference according to the levels of IL - 6, IL - 8 and TNF - α between two groups before operation （P 〉 0.05 ）. The levels of IL - 6, IL - 8 and TNF - α were significantly increased in two groups after operation. The levels of IL - 6, IL - 8 and TNF - α in the combined group were significantly lower than those in the control group, and the difference was statistically significant （P 〈 0.05 ）. The dosage of 48 h morphine was （ 22.4 ± 4.2） mg, and the combination group was （ 15.2 ± 3.5 ） mg, and the dosage of com- bined group was significantly lower than that of intravenous group （ P 〈 0.05 ）. In two groups after the treatment for 3 months, according to the knee function comparison, KSS score, maximum flexion, the maximum extension the difference was not significant（P 〉0.05）. There was a small amount of dizziness, headache and other ad- verse reactions in the treatment ,with the improvement after symptomatic treatment, and there was no difference between groups （ P 〉 0. 05 ）. Conclusion： The analgesic effect of acupuncture combined with intravenous analgesia after arthroscopic knee ligament reconstruction is obvious, and the patients＇inflammatory condition is obviously improved, and the knee joint function is obviously improved, and the safety is high.