腰方肌髂筋膜阻滞对全髋置换围术期的影响

Effects of quadratus lumborum and iliacfascia block on perioperative reaction of total hip arthroplasty

[目的]评价腰方肌髂筋膜阻滞对全髋关节置换围术期炎症反应和胰岛素抵抗的影响。[方法]选取本院择期初次行单侧人工全髋关节置换术患者60例,采用随机数字表法分为两组,每组30例。常规组患者行全身麻醉,阻滞组患者行腰方肌联合髂筋膜阻滞后联合全身麻醉。比较两组临床结果。于麻醉前10 min、术后即刻、术后24 h、术后72 h抽取外周静脉血,检测两组患者血清中炎性介质C反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子α(TNF-α)水平;同时检测两组患者血清中血糖浓度和胰岛素浓度,计算胰岛素抵抗指数(IRI)。[结果]两组患者手术时间、术中失血量差异无统计学意义(P>0.05);但阻滞组术中瑞芬太尼的用量显著低于常规组(P<0.05)。常规组术中心律失常发生率为23.33%,而阻滞组为6.67%,差异有统计学意义(P<0.05);常规组围术期不良反应发生率为33.33%,而阻滞组为13.33%,差异有统计学意义(P<0.05)。两组患者的CRP、IL-6、TNF-α和IRI在术后即刻开始升高、术后24 h时达到峰值,术后72 h下降,不同时间点间的差异均有统计学意义(P<0.05)。麻醉前10min两组间CRP、IL-6、TNF-α和IRI的差异无统计学意义(P>0.05);但术后即刻和术后24 h时,常规组的CRP、IL-6、TNF-α和IRI均显著高于阻滞组(P<0.05),至术后72 h,常规组的上述4项指标仍高于阻滞组,但差异已无统计学意义(P>0.05)。[结论]腰方肌联合髂筋膜阻滞可减轻全髋关节置换围术期炎症反应,降低患者胰岛素抵抗。

[Objective]To explore the effects of quadratus lumborum and iliac fascia block on perioperative inflammatory response and insulin resistance in primary total hip arthroplasty(THA).[Methods]A total of 60 patients who were undergoing unilateral THA were enrolled into this study,and randomly divided into two groups by random numerical table method with 30 patients in each group.The patients in the routine group had THA performed under general anesthesia,while those in the block group had operation conducted under quadratus lumborum and iliac fascia block combined with general anesthesia.The perioperative clinical outcomes were documented and compared between the two group,in addition,the C-reactive protein(CRP),interleukin-6(IL-6)and tumor necrosis factorα(TNF-α),as well as insulin resistance index(IRI)calculated by blood sugar and insulin were measured by using venous blood sample harvested at 10 min before anesthesia,immediately,24 hours and 72 hours after operation.[Results]Although no significant differences in operation time and intraoperative blood loss were proved between the two group(P>0.05),the block group consumed significantly less remifentanil than the routine group during operation(P<0.05).The intraoperative incidence of cardiac arrythmia proved of 23.33%in the routine group,whereas 6.67%in the block group with a statistical significance(P<0.05).On the other hand,the adverse reaction after operation was 33.33%in the routine group,while 13.33%in the block group,which proved statistically significant(P<0.05).The CRP,IL-6,TNF-αand IRI significantly raised immediately after operation,reach to the peak at 24 hour after operation,and declined at 72 hours after operation,which proved statistically significant among time points in both groups(P<0.05).Although there were no significant differences in CRP,IL-6,TNF-αand IRI between the two groups at 10 min before anesthesia,the routine group had higher CRP,IL-6,TNF-αand IRI than the block group,which proved statistically significant immediately after operation and at 24 hours pos tope rati vely(P<0.05),while became statistically insignificant at 72 hours after operation(P>0.05).[Conclusion]This quadratus lumborum and iliac fascia block does reduce perioperative inflammatory response,and improve insulin resistance in primary total hip arthroplasty.