神经刺激仪引导下神经阻滞对下肢手术后疼痛介质分泌及应激程度的影响

Effect of nerve stimulator-guided nerve block on the pain mediator secretion and stress degree after lower extremity operation

目的:研究神经刺激仪引导下神经阻滞对下肢手术后疼痛介质分泌及应激程度的影响。方法:选择绵阳市骨科医院2015年3月~2017年8月期间进行下肢手术患者,并对病历资料内的镇痛方法进行回顾,根据镇痛方法不同分入神经阻滞组、椎管镇痛组、静脉镇痛组。术后24h,测定血清中疼痛介质、应激激素、应激产物及炎症因子的分泌量。结果:神经阻滞组患者血清中降钙素基因相关肽(CGRP)、β-内啡肽(β-EP)、5-羟色胺(5-HT)、HA、促肾上腺皮质激素(ACTH)、皮质醇(Cor)、PRL、生长激素(GH)、促甲状腺激素(TSH)、sTNFR-1、白介素(IL)-2、IL-10、转化生长因子(TGF)-β1的分泌量以及C反应蛋白(CRP)、髓过氧化物酶(MPO)、丙二醛(MDA)、活性氧(ROS)的生成量均显著低于椎管镇痛组、静脉镇痛组,神经阻滞组与椎管镇痛组比较、神经阻滞组与静脉镇痛组比较血清中疼痛介质、应激激素、应激产物及炎症因子的差异有统计学意义(P<0.05)。结论:神经刺激仪引导下神经阻滞能够较椎管内镇痛及静脉镇痛更为有效减少下肢手术后疼痛介质的分泌,并减轻应激程度。

Objective：To study the effect of nerve stimulator-guided nerve block on the pain mediator secretion and stress degree after lower extremity operation.Methods：Patients who underwent lower extremity operation in Mianyang Orthopaedic Hospital between March 2015 and August 2017 were selected,and the analgesia methods within the medical records were reviewed and used to divide the patients into 3 groups：nerve block group,spinal analgesia group and intravenous analgesia group.The secretion of pain mediators,stress hormones,stress products and inflammatory factors in serum was measured 24 hours after surgery.Results：CGRP,β-EP,5-HT,HA,ACTH,Cor,PRL,GH,TSH,sTNFR-1,IL-2,IL-10 and TGF-β1 secretion as well as CRP,MPO,MDA and ROS generation in serum of nerve block group were significantly lower than those of spinal analgesia group and intravenous analgesia group（P〈0.05）,and the differences in serum pain mediators,stress hormones,stress products and inflammatory factors were statistically significant between nerve block group and spinal analgesia group as well as between nerve block group and intravenous analgesia group（P〈0.05）.Conclusion：The nerve stimulatorguided nerve block can be more effective than spinal analgesia and intravenous analgesia to reduce the secretion of pain mediators and relieve the degree of stress after lower extremity operation.