地塞米松应用时机对硬膜外麻醉神经根损伤患者血清炎性因子及疗效的影响

Impact of timing of dexamethasone on inflammatory factors and curative effect for patients with nerve root injury caused by epidural anesthesia

目的探讨地塞米松应用时机对硬膜外麻醉术后神经根损伤与炎性细胞因子的影响。方法选择行硬膜外麻醉下剖宫产分娩术麻醉过程中出现神经根损伤患者120例,根据地塞米松应用时机分为A组(出现神经根损伤即刻使用),B组(手术结束时使用),C组(未使用)各40例。比较3组术后24、48、72h肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素1β(interleukin-1β,IL-1β)、IL-6水平改变情况以及术后2周神经根损伤恢复情况。结果 3组手术时间及术中出血量差异均无统计学意义(P>0.05)。A组和B组神经根损伤的临床疗效优于C组,优良率高于C组(P<0.05)。3组血清TNF-α、IL-1β、IL-6水平呈逐渐增高趋势,A组增高幅度最小,C组增高幅度最大,其组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05)。结论地塞米松对于剖宫产手术硬膜外麻醉中神经根损伤具有良好临床疗效,且在神经根损伤后早期硬膜外应用地塞米松,效果可能更佳。

Objective To investigate the impact of timing of dexamethasone on nerve injury after cesarean section and inflammatory factors. Methods One hundred and twenty cases of nerve injury in our hospital undergoing epidural anesthesia for cesarean section in the process of puncturing patients were selected as the research objects. According to whether the application to dexamethasone and application time, the patients were divided into group A （dexamethasone using immediately after nerve injury）, group B（dexamethasone using at surgery end time）, group C（control group）.Each group of tumor necrosis factor-a（TNF-a）, interleukin-1β（IL-1β）, interleukin-6（IL-6） level after 24 h, 48 h, 72 h and the nerve injury recovering were observed. Results There were no significant difference in operation time and intraoperative bleeding volume between the 3 groups（P〉0.05）. The clinical efficacy of nerve root injury in group A and group B was better than that in group C, and the excellent rate was higher than that in group C （P〈0.05）. The serum levels of TNF-a, IL-1β and IL-6 increased gradually in the 3 groups, and the increased extent of group A were minimum, while the increased extent of group C were maximum. The differences of interaction among groups, time points, between groups and time points were statistically significant （P〈 0. 05）. Conclusion Dexamethasone treating cesarean epidural puncturing nerve root injury is worthy of clinical application, dexamethasone could reduce the level of TNF-a, IL-1β, IL-6, which efficacy. and earlier application of indicates better clinicalefficacy.