超声引导下连续臂丛神经阻滞对肘关节恐怖三联征内固定术患者应激、炎性反应及术后镇痛效果的影响

Effects of ultrasound guided continuous infraclavicular brachial plexus block on stress reaction, inflammatory response and postoperative analgesia in patients with internal fixation of terrible triad of the elbow

目的比较超声引导下连续锁骨下臂丛神经阻滞和静脉自控镇痛对肘关节恐怖三联征内固定术患者应激、炎性反应及术后镇痛效果的影响。方法采用前瞻性研究方法,收集2016年3月至2017年8月在宁波市第六医院择期行肘关节恐怖三联征内固定术患者60例,性别不限,年龄18~70岁,ASA分级I或Ⅱ级,按照随机数字表法将其随机分为患者静脉自控镇痛(PCIA)组和超声引导下连续锁骨下臂丛神经阻滞(CIPB)组,每组30例。两组患者于全身麻醉苏醒后,连接电子自控镇痛泵,PCIA组配方为舒芬太尼2 pcg/kg,生理盐水稀释至100 ml,背景输注速率2ml/h,锁定时间15 min, PCIA剂量2 ml;CIPB组药液配方为0.2%罗哌卡因,背景输注速率5ml/h,锁定时间15 min, PC A剂量5 ml,镇痛至术后3(I记录术后6J2h及术后1、2、3(1时静息VAS评分和动态VAS评分、吗啡补救用量及不良反应情况;并检测术前、术后6、12h及术后1、2、3 d时血清白介素-6(IL-6)、白介素-IO(IL-IO)、皮质醇(Cor)和去甲肾上腺素(NE)水平。结果术前两组患者上述各指标比较差异无统计学意义(P>0.05)。与PCIA组比较,CIPB组患者术后各时点静息VAS评分和动态VAS评分均较低(P<0.05). CIPB组患者不良反应发生率低于PCIA组(P<0.05)。与PCIA组比较,CIPB组患者术后各时点,血清IL-6、JL-10、Cor、NE水平均较低(P<0.05)。结论连续锁骨下臂丛神经阻滞可有效用于肘关节恐怖三联征患者的术后镇痛,且可减轻患者的应激反应和炎性反应。

Objective To compare the effects of ultrasound guided continuous infraclavicular brachial plexus block with patient controlled intravenous analgesia on stress reaction, inflammatory response and postoperative an algesia in patients with internal fixation of terrible triad of the elbow. Methods Sixty patients of both sexes with terrible triad of the elbows in Ningbo Sixth Hospital undergoing internal fixation, from March 2016 to August 2017, aged 18-80 years, ASA I or II, were randomly divided into 2 groups (n=30): patient controlled intravenous analgesia (PCIA group) and continuous infraclavicular brachial plexus block (CIPB group). After the end of operation, the electronic pump was connected to the catheter in all patients. PCIA solution contained sufentanil 2 pig/kg in normal saline 100 ml. The PCIA pump was set up to deliver a 2 ml bolus dose with a 15 min lockout interval and background infusion at 2 m 1 /h. CIPB solution contained 0.2% ropivacaine and the pump was set up to deliver a 5 ml bolus dose, with a 15 min lockout interval and background infusion at 5 ml/h. Postoperative analgesia sustained for 3 d after the operation in both groups. VAS was recorded at 6, 12 h and 1, 2, 3 d after the operation during rest and rehabilitation exercise. Rescue dose of morphine and side effects were also recorded at the same time. The serum levels of IL-6. IL-10 and Cor, NE were monitored before the operation and at 6, 12 h and 1, 2, 3 d postoperatively. Results There were no differences in all of the preoperative indexes between the two groups (P>0.05). Compared with PCIA group. V AS was significantly decreased during rest and rehabilitation exercise at each time point after the operation in CIPB group. Compared with PCIA group, the levels of IL-6. IL-10. Cor and NE were lower significantly in CIPB group at each time point after the operation (P<0.05). Conclusion Ultrasound guided continuous infraclavicular brachia) plexus block can effectively alleviate the postoperative pain after fixation for terrible triad of the elbows, and can also alleviate the stress reaction and inflammatory response.