氟比洛芬酯联合髂筋膜间隙阻滞对全髋关节置换术后炎症反应及疼痛的影响

The effects of flurbiprofen axetil combined with iliac fascial block on postoperative inflammation and pain after total hip arthroplasty

目的探讨氟比洛芬酯联合髂筋膜间隙阻滞对全髋关节置换术后炎症反应及疼痛的影响。方法选取2016年3月至2018年9月在郑州市第三人民医院骨科择期行全髋关节置换术患者168例,随机分为氟比洛芬酯组(56例)、阻滞组(56例)和联合组(56例)。氟比洛芬酯组患者于麻醉诱导前5 min静脉注射氟比洛芬酯,术毕行经静脉患者自控镇痛(PCIA)(氟比洛芬酯、舒芬太尼、昂丹司琼和生理盐水混合液),持续用药48 h。阻滞组术前行髂筋膜间隙阻滞,术后留置导管与自控镇痛泵连接(舒芬太尼、昂丹司琼及生理盐水混合液),持续用药48 h。联合组患者接受髂筋膜间隙阻滞方法同阻滞组,术毕行PCIA,方法同氟比洛芬酯组。评价指标包括:术后6 h(T 1)、12 h(T 2)、24 h(T 3)、48 h(T 4)和72 h(T 5)时患者静息状态的疼痛视觉模拟评分(VAS)及T 3、T 4和T 5时活动状态的VAS评分。T 4和T 5时患者肌力评级及睡眠质量评分。术前(T 0)、T 3、T 4和T 5时患者血浆白细胞介素(IL)-1β、IL-6和肿瘤坏死因子(TNF)-α水平。各组患者不良事件发生情况。结果联合组患者T 2、T 3、T 4和T 5时静息状态VAS评分及T 4和T 5时活动状态VAS评分均低于阻滞组和氟比洛芬酯组,且阻滞组低于氟比洛芬酯组(P均<0.05)。联合组患者T 3、T 4和T 5时血浆IL-1β、IL-6和TNF-α水平均低于阻滞组和氟比洛芬酯组,且阻滞组低于氟比洛芬酯组(P均<0.05)。联合组和阻滞组患者恶心呕吐、嗜睡和排尿困难发生率均低于氟比洛芬酯组(P均<0.05)。结论氟比洛芬酯联合髂筋膜间隙阻滞应用于全髋关节置换术后镇痛,可降低患者术后VAS评分,改善患者睡眠质量,减轻炎症反应,并减少患者术后不良反应发生。

Objective To investigate the effects of flurbiprofen axetil combined with iliac fascial block on postoperative inflammation and pain after total hip arthroplasty.Methods A total of 168 cases of patients who were planning to receive elective total hip arthroplasty in the Orthopaedic department in the Third People’s Hospital of Zhengzhou from March 2016 to September 2018 were selected and randomly divided into the Flurbiprofen axetil group(n=56),the Block group(n=56)and the Combination group(n=56).In the Flurbiprofen axetil group,5 min before anesthesia induction,patients were intravenously injected with flurbiprofen axetil,and received patient controlled intravenous analgesia(PCIA)(flurbiprofen axetil,sufentanil,ondansetron and saline solution)for 48 h,postoperatively.In the Block group,before the operation,patients underwent the iliac fascial block,and after the operation,the indwelling catheter was connected with the self-controlled analgesia pump(sufentanil,ondansetron and saline solution)lasting for 48h.In the Combination group,patients firstly received the iliac fascial block,which was the same as the Block group,and then were prescribed with PCIA postoperatively,as the Flurbiprofen axetil group.The severity of pain was assessed by visual analog scale(VAS)at 6 h(T 1),12 h(T 2),24 h(T 3),48 h(T 4)and 72 h(T 5)after operation during rest and at T 3,T 4 and T 5 during active states.Patient’s muscle strength rating and sleep quality at T 4 and T 5 were evaluated.The levels of interleukin-1β(IL-1β),IL-6 and tumor necrosis factor-α(TNF-α)in the plasma before surgery(T 0),and at T 3,T 4 and T 5 were detected.Adverse events in each group were recorded.Results The VAS scores at T 2,T 3,T 4 and T 5 during rest and at T 4 and T 5 during active state in the Combination group were lower than those in the Block group,which were lower than those in the Flurbiprofen axetil group(both P<0.05).The plasma levels of IL-1β,IL-6 and TNF-αat T 3,T 4 and T 5 in the Combination group were lower than those in the Block group,which were lower than those in the Flurbiprofen axetil group(both P<0.05).The incidence of malignant vomiting,lethargy and dysuria in the Combination group and the Block group were lower than those in the Flurbiprofen axetil group(both P<0.05).Conclusion The flurbiprofen axetil combined with iliac fascial block applying for analgesia after total hip arthroplasty can reduce postoperative VAS score,improve sleep quality,alleviate inflammatory response,and postoperative adverse reactions.