罗哌卡因髂筋膜间隙阻滞联合地佐辛多模式镇痛对髋关节置换术后疼痛及应激反应的影响

Effect of ropivacaine fascia iliaca compartment block combined with dezocine multimodal analgesia on the pain and stress response after hip replacement

目的:研究罗哌卡因髂筋膜间隙阻滞联合地佐辛多模式镇痛对髋关节置换术后疼痛及应激反应的影响。方法:选择在本院接受髋关节置换术的74例老年患者,随机分为多模式镇痛组(MMA组)以及自控静脉镇痛组(PCIA组),MMA组接受罗哌卡因髂筋膜间隙阻滞、地佐辛超前镇痛联合自控静脉镇痛,PCAI组接受自控静脉镇痛。术后即刻及术后12小时,检测血清中疼痛相关分子、应激相关激素的含量以及外周血中应激相关免疫分子的含量。结果:术后12小时,两组患者血清中SP、PGE2、TNF-α、IL-1β、IL-10、FC、NE、E、GH的含量以及外周血中Foxp3+细胞的荧光强度均显著高于术后即刻,外周血中CD3+、CD4+、CD8+细胞的荧光强度均显著低于术后即刻且MMA组患者术后12小时血清中SP、PGE2、TNF-α、IL-1β、IL-10、FC、NE、E、GH的含量以及外周血中Foxp3+细胞的荧光强度均显著低于PCIA组,外周血中CD3+、CD4+、CD8+细胞的荧光强度均显著高于PCIA组。结论:罗哌卡因髂筋膜间隙阻滞联合地佐辛多模式镇能够减轻髋关节置换术后的疼痛及应激反应。

Objective：To study the effect of ropivacaine fascia iliaca compartment block combined with dezocine multimodal analgesia on the pain and stress response after hip replacement.Methods：A total of 74 cases of elderly patients who received hip replacement in Mianyang Central Hospital were selected,and randomly divided into multimodal analgesia group（MMA group）and patient-controlled intravenous analgesia group（PCIA group）,MMA group received ropivacaine fascia iliaca compartment block,dezocine preemptive analgesia combined with patient-controlled intravenous analgesia,and PCAI group received patient-controlled intravenous analgesia.The levels of pain-related molecules and stress-related hormones in serum as well as the levels of stress-related immune molecules in peripheral blood were detected immediately after surgery and12 hours after surgery.Results：Twelve hours after surgery,serum SP,PGE2,TNF-α,IL-1β,IL-10,FC,NE,E and GH levels and peripheral blood Foxp3＋ cell fluorescence intensity of both groups of patients were significantly higher than those immediately after surgery,peripheral blood CD3＋,CD4＋,CD8＋cell fluorescence intensity were significantly lower than those immediately after surgery,serum SP,PGE2,TNF-α,IL-1β,IL-10,FC,NE,E and GH levels and peripheral blood Foxp3＋cell fluorescence intensity of MMA group 12 hours after surgery were significantly lower than those of PCIA group,and peripheral blood CD3＋,CD4＋,CD8＋cell fluorescence intensity were significantly higher than those of PCIA group.Conclusion：Ropivacaine fascia iliaca compartment block combined with dezocine multimodal analgesia can reduce the pain and stress response after hip replacement.