腰椎术后反应性疼痛与引流液中炎症因子的相关性分析

Correlation between lumbar spinal reactive pain and inflammatory factors in drainage fluid after lumbar spinal surgery

目的探究腰椎手术后反应性疼痛与引流液中炎症因子的相关性。方法 2016-01-2017-01于我院采用椎间盘切除、椎间植骨融合内固定术、后路椎板减压治疗25例腰椎间盘突出患者,术后1、2、3 d采用视觉模拟法(Visual Analogue Scale/Score,VAS)评分法进行疼痛评分,并取伤口引流液,检测引流液肿瘤坏死因子α(tumor necrosis factorα,TNF-α)、白细胞介素(interleukin1β、6,IL-1β、IL-6)、C反应蛋白(C-reactionprotein,CRP)水平,同时期检测红细胞沉降率(erythrocyte sedimentation rate,ESR),并探讨各炎性因子与VAS评分、CRP水平以及ESR的相关性。结果术后2、3 d VAS评分显著高于术后1 d,差异具有统计学意义(P<0.05),术后2、3 d差异无统计学意义(P>0.05);术后2 d、3 d ESR评分显著高于术后1 d,术后2 d显著高于术后3 d,差异具有统计学意义(P<0.05);术后2、3 d CRP水平显著高于术后1 d,术后3 d显著高于术后2d,差异具有统计学意义(P<0.05);术后2 d、3 d IL-1β、IL-6、TNF-α水平均显著高于术后1 d,术后3 d显著高于术后2 d,差异具有统计学意义(P<0.05);引流液IL-1β、IL-6、TNF-α水平与术后VAS评分呈正相关(P<0.05),与CRP、ESR无显著相关性(P>0.05)。结论腰椎术后下肢或腰臀部反应性疼痛与引流液中IL-1β、IL-6、TNF-α等炎症因子水升高密切相关。

Objective To explore the correlation between lumbar spinal reactive pain and inflammatory factors in the drainage fluid after lumbar spinal surgery. Methods From January 2016 to January 2017, 25 patients with lumbar disc herniation were treated by diskectomy, interbody fusion and internal fixation, posterior lumbar decompression, postoperative reactive pain of the low lumbar or lower limb occurred. Visual analogue scale（VAS） score was used to record low back pain at 1-3 d post-operation. The tumor necrosis factor-α （TNF-α）, interleukin-1β （IL-1β）, interleukin-6 （IL-6） and C-reactive protein（CRP） in wound drainage fluid were tested at 1-3 d post-operation continuously. And erythrocyte sedimentation rate（ESR） was detected at the same time. The correlations of inflammatory factors with VAS scores,CRP and ESR were statistically analyzed. Results The VAS score at 2,3 d post-operation was significantly higher than that at 1 day post-operation（P〈0.05）, VAS score had no significant difference at postoperative 2 d and 3 d（P〉0.05）. The ESR score at 2,3 d post-operation was significantly higher than that at 1 day post-operation （P〈0.05）. The level of CRP at 2,3 d post-operation was significantly higher than that at 1 day post-operation, CRP at postoperative 3 d was significantly higher than postoperative 2 d （P〈0.05）. The levels of IL-1β, IL-6 and TNF-α at 2,3 d post-operation were significantly higher than that at 1 day post-operation, those at postoperative 3 d were significantly higher than postoperative 2 d（P〈0.05）. There was a positive correlation between the levels of IL-1β, IL-6 and TNF-α in drainage fluid and the postoperative VAS score（P〈0.05）, and there was no significant correlation with CRP and ESR （P〉0.05）. Conclusion The reactive pain after lumbar surgery is correlated with the concentration of IL-1β,IL-6 and TNF-α in drainage fluid.