PCIA与FNB对TKA患者术后镇痛早期血清炎性因子水平影响临床研究

Clinical study on effects of PCIA and FNB on serum inflammatory factors during postoperative early analgesia in patients with TKA

目的分析静脉自动镇痛(PCIA)与连续股神经阻滞(FNB)对全膝关节置换术(TKA)患者早期血清炎性因子水平的影响,找出TKA术后理想的镇痛方式。方法选取该院2017年3月至2019年5月收治的择期行TKA患者84例,根据随机数字表法分为I组(n=48)与F组(n=36)。两组患者术中均采用腰硬联合麻醉,比较两组患者术中止血带时间及出血量、术后2周切口愈合情况及膝关节功能评分情况;在完成手术后I组采用PCIA,F组采用FNB镇痛。比较两组患者术后1、6、12、24、36、48 h时疼痛视觉模拟评分(VAS),包括被动活动评分(PVAS)、静息状态评分(RVAS);同时检测并比较两组患者术前及术后1、6、12、24、48 h时血清部分炎性因子水平变化情况,包括:肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、C反应蛋白(CPR);同时观察两组患者术后不同镇痛方式所产生的不良反应发生率和是否加用了其他镇痛方式。结果两组患者术中止血带时间及出血量、术后2周切口愈合情况及膝关节功能评分对比无明显差异;F组术后1 h较I组PVAS、RVAS无明显差异,但在术后6、12、24、36、48 h时PVAS、RVAS低于I组(P<0.05);术前及术后1、24、48 h两组患者TNF-α、IL-6、CPR水平比较,差异无统计学意义(P>0.05),F组在术后6、12 h检测TNF-α、IL-6、IL-1β水平明显低于I组(P<0.05);术后两组不同镇痛方式所致患者不良反应发生率及是否加用了其他镇痛模式比例,F组较I组明显降低。结论TKA患者术后采取PCIA与FNB均可达到理想的镇痛,两种方法都能使患者体内的血清炎性因子水平维持在一个较低水平,但FNB能够使早期血清炎性因子水平维持得更低,且不良反应发生率更低。

Objective To analyze the effects of patient controlled intravenous analgesia(PCIA)and continuous femoral nerve block(FNB)on serum inflammatory factor levels during early stage in the patients with total knee arthroplasty(TKA),and to find the ideal analgesic method after TKA.Methods Eighty-four patients undergoing elective TKA admitted to this hospital from March 2017 to May 2019 were selected and divided into the group I(n=48)and F(n=36)according to the random number table method.The two groups adopted the combined spinal and epidural anesthesia.The intraoperative tourniquet time and blood loss volume,healing situation of incision in postoperative 2 weeks and the score of knee function were compared between the two groups.The group I Adopted PCIA after operation,while the group F used FNB analgesia.The pain visual analogue scale(VAS)scores at postoperative 1,6,12,24,36,48 h were compared between the two groups,including:passive activity(PVAS)and resting state(RVAS);the changes of serum partial inflammatory factors before operation and at postoperative 1,6,12,24,48 h,including the tumor necrosis factor alpha(TNF-α),interleukin-6(IL-6),C-reactive protein(CPR);meanwhile the incidence rates of adverse reactions caused by different analgesic modes in the two groups and whether adding the other analgesic methods were observed.Results There was no statistically significant difference in the intraoperative tourniquet time,bleeding volume,incision healing and knee function score in postoperative 2 weeks between the two groups.There was no significant difference in the PVAS and RVAS scores at postoperative 1 h between the group I and F,but the PVAS and RVAS scores at postoperative 6,12,24,36,48 h in the group F were lower than those in the group I(P<0.05).There was no statistically significant difference in the TNF-α,IL-6 and CPR levels before operation and at postoperative 1,24,48 h between the two groups(P>0.05),the levels of TNF-α,IL-6 and IL-1βat postoperative 6,12 h in the group F were significantly lower than those in the group I(P<0.05).The incidence rate of adverse reactions caused by different analgesic modes and the proportion of adding other analgesic modes in the group F were significantly decreased compared with the group I.Conclusion Adopting PCIA and FNB after operation in the patients with TKA can achieve ideal analgesia.Both methods can maintain serum inflammatory factors in a low levels.But FNB can maintain the lower levels of early serum inflammatory factors,moreover has a lower incidence rate of adverse reactions.