硬膜外阻滞联合全身麻醉用于髋关节置换术效果观察及对患者血清炎性因子的影响

Effect of epidural anesthesia combined with general anesthesia on the expression of serum IL-6,IL-8 and CRP in patients undergoing hip replacement

目的探讨硬膜外阻滞联合全身麻醉用于髋关节置换术的效果及其对患者血清白细胞介素6(IL-6)、白细胞介素8(IL-8)和C反应蛋白(CRP)表达的影响。方法选择诸暨市人民医院2017年2月至2018年2月收治的行髋关节置换术患者82例为研究对象,按照随机数字表法分为对照组41例与观察组41例。观察组采用硬膜外阻滞联合全身麻醉,对照组采用全身麻醉。比较两组拔管时间和苏醒时间,术前、术后3 h和术后24 h简易精神状态量表(MMSE)评分和炎性因子变化。结果观察组拔管时间(10.93±2.41)min和苏醒时间(17.85±3.24)min,均短于对照组的(16.29±2.73)min和(23.94±2.46)min(t=9.425、9.586,均P<0.05)。观察组MMSE评分术后3 h(25.48±1.43)分和术后24 h(26.83±1.09)分,均高于对照组的(23.09±1.60)分和(25.32±1.42)分(t=7.132、5.401,均P<0.05);观察组血清IL-6、IL-8和CRP水平术后3 h(28.93±3.54)ng/L、(37.92±6.73)ng/L、(18.93±3.25)mg/L和术后24 h(21.09±1.76)ng/L、(28.76±3.25)ng/L、(10.39±2.67)mg/L,均低于对照组术后3 h的(49.97±5.46)ng/L、(64.32±8.98)ng/L、(29.90±4.36)mg/L和术后24 h(34.52±3.49)ng/L、(43.65±5.61)ng/L、(18.89±2.34)mg/L(术后3 h:t=20.704、15.064、12.917,术后24 h:t=22.001、14.706、15.330,均P<0.05)。结论硬膜外阻滞联合全身麻醉较单纯全身麻醉用于髋关节置换术临床效果好,且可减少术后认知功能障碍的发生,抑制炎性反应。

Objective To investigate the clinical effect of epidural anesthesia combined with general anesthesia on the expression of serum interleukin 6(IL-6),interleukin 8(IL-8)and C-reactive protein(CRP)in patients undergoing hip replacement.Methods From February 2017 to February 2018,82 patients who underwent hip replacement in Zhuji People's Hospital were selected in the research.According to the random table method,the patients were divided into two groups,with 41 patients in each group.The observation group was given epidural anesthesia combined with general anesthesia,while the control group was given general anesthesia.The extubation time and recovery time,the scores of MMSE and the changes of inflammatory factors at preoperation,postoperative 3h and postoperative 24h were compared between the two groups.Results The extubation time and recovery time of the observation group[(10.93±2.41)min and(17.85±3.24)min]were shorter than those of the control group[(16.29±2.73)min and(23.94±2.46)min](t=9.425,9.586,all P<0.05).The scores of MMSE in the observation group at postoperative 3h[(25.48±1.43)points]and postoperative 24h[(26.83±1.09)points]were higher than those in the control group[(23.09±1.60)poinrts and(25.32±1.42)points](t=7.132,5.401,all P<0.05).The serum levels of IL-6,IL-8 and CRP in the observation group at postoperative 3h[(28.93±3.54)ng/L,(37.92±6.73)ng/L,(18.93±3.25)mg/L]and postoperative 24h[(21.09±1.76)ng/L,(28.76±3.25)ng/L,(10.39±2.67)mg/L]were lower than those in the control group[3h after operation:(49.97±5.46)ng/L,(64.32±8.98)ng/L,(29.90±4.36)mg/L;24h after operation:(34.52±3.49)ng/L,(43.65±5.61)ng/L,(18.89±2.34)mg/L](3h after operation:t=20.704,15.064,12.917;24h after operation:t=22.001,14.706,15.330,all P<0.05).Conclusion Epidural anesthesia combined with general anesthesia has better clinical effect than general anesthesia alone in patients with hip replacement,and can reduce the occurrence of cognitive dysfunction and inhibit the release of inflammatory reaction after operation,which is worthy of clinical reference.