酮咯酸氨丁三醇超前镇痛对膝骨关节炎关节置换患者炎性因子及应激状态的影响

Effect of ketorolac tromethamine preemptive analgesia on inflammatory factors and stress status in patients with knee osteoarthritis

目的探讨酮咯酸氨丁三醇超前镇痛对膝骨关节炎关节置换患者炎性因子及应激状态的影响。方法选择因膝骨关节炎接受膝关节置换患者61例，随机分为对照组（30例）及观察组(31例),对照组仅接受静脉麻醉复合硬膜外阻滞，观察组在此基础上接受酮咯酸氨丁三醇超前镇痛，对比分析2组患者术前及术后VAS评分、细胞因子及皮质醇检测水平。结果观察组患者的术后疼痛VAS评分（24h、48h、72h）均明显低于对照组(P<0.05)；观察组术后24h患者IL-8、TNF-α水平明显低于对照组(P<0.05)，观察组术后48h的IL-6、IL-8、TNF-α水平均明显低于对照组(P<0.05)。观察组患者术后24hCor明显低于对照组同期水平（P<0.05），观察组术后48hCor及ACTH水平均明显低于对照组(P<0.05)。结论酮咯酸氨丁三醇超前镇痛可明显缓解膝骨关节炎关节置换术后疼痛，并且可显著降低炎性因子水平，减轻患者术后应激状态。

Objective To study the ketone luo acid tromethamine analgesia in patients with knee osteoarthritis joint replacement inadvance of inflammatory factor and the influence of stress state.Methods Choice for knee osteoarthritis knee joint replacement patients61cases,were randomly divided into control group(30caese)and the observation group(31caese),the control group only receivedintravenous anesthesia compound epidural block,on the basis of the observation group receied ketone luo acid tromethamine analgesiain advance,the contrast analysis of two groups of patients with preoperative and postoperative VAS score,cytokines and cortisol levels.Results The observation group of patients with postoperative pain VAS score(24h,48h,72h)were significantly lower than control group(P<0.05);Observation group with24h after IL-8,TNF alpha level significantly lower than the control group(P<0.05),the observation groupafter48h of IL-6,IL-8,TNF-a levels were significantly lower than control group(P<0.05).0bservation group24h after surgery in patients with Corsignificantly lower than the control level(P<0.05),after48h Cor and ACTH level observation group were significantly lower than the controlgroup(P<0.05).Conclusion Ketone luo acid tromethamine analgesia in advance can obviously relieve knee osteoarthritis pain after jointreplacement,and can significantly reduce inflammatory factor lev els,reduce the postoperative patients with stress state.