术前应激反应对关节置换手术患者术后疼痛的影响

Influence of preoperative stress response on postoperative pain of patients undergoing joint replacement

目的分析术前应激反应对关节置换手术患者术后疼痛的影响,以期能为后期治疗护理提供指导。方法采用前瞻性分析的研究方法,依据纳入标准和排除标准筛选后共纳入2019年8月至2020年8月期间来广州医科大学附属第一医院进行治疗的102例关节置换手术患者为研究对象。对术前及术后6个月患者血清内氧化应激指标含量进行t检验比较,术后使用视觉模拟评分(VAS)量表评估疼痛情况,并以Pearson相关性分析患者关节置换手术前后的应激情况与术后疼痛的相关性。结果与术前比较,术后患者的血清氧化指标丙二醛(MDA)、髓过氧化物酶(MPO)和晚期蛋白氧化产物(AOPPs)含量均显著降低;血清抗氧化指标,如超氧化物歧化酶(SOD)、总抗氧化能力(T-AOC)、谷胱甘肽过氧化物酶(GSH-Px)含量均升高(t=2.365、3.929、2.175、2.419、2.319、2.263,均为P<0.05)。与术前比较,术后患者的血清炎症因子白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)和C反应蛋白(CRP)含量均显著降低(t=4.137、2.421、4.763、3.827、2.274,均为P<0.05)。术前第3天疼痛VAS评分为(4.1±1.1)分。术前血清MDA、MPO、AOPPs含量与术后疼痛呈现正相关(r=0.421、0.371、0.486,均为P<0.05);SOD、T-AOC、GSH-Px含量与术后疼痛呈现负相关(r=-0.135、-0.176、-0.332,均为P<0.05);术前血清IL-2、IL-6、IL-8、TNF-α和CRP含量与术后疼痛呈现正相关(r=0.426、0.411、0.548、0.223、0.302,均为P<0.05)。结论术前应激反应和炎症反应与关节置换手术患者术后疼痛存在密切相关性,术前应激反应和炎症反应越重的患者术后疼痛越明显。

Objective To analyze the influence of preoperative stress response on postoperative pain in patients undergoing joint replacement surgery,in order to provide guidance for later clinical treatment.Methods A total of 102 patients with joint replacement surgery who received treatment in our hospital from August 2019 to August 2020 were included in the prospective analysis according to the inclusion criteria and exclusion criteria.The serum oxidative stress index content of the patients before and six months after surgery was compared by t test.Visual analogue scale(VAS)was used to evaluate the pain situation after surgery.The correlation between stress and postoperative pain before and after joint replacement surgery was analyzed by Pearson correlation.Results Compared with preoperation,the contents of malondialdehyde(MDA),myeloperoxidase(MPO)and advanced protein oxidation products(AOPPs)in serum of postoperative patients significantly decreased;serum antioxidant indicators,such as superoxide dismutase(SOD)and total antioxidant capacity(T-AOC),glutathione peroxidase(GSH-Px)levels were elevated(t=2.365,3.929,2.175,2.419,2.319,2.263,all P<0.05).Compared with preoperative and postoperative serum inflammatory factors in patients with interleukin-2(IL-2)and interleukin 6(IL-6)and interleukin 8(IL-8),tumor necrosis factor alpha(TNFα)and c-reactive protein(CRP)levels were significantly lower(t=4.137,2.421,4.763,3.827,2.274,all P<0.05).The VAS score on the third day before surgery was(4.1±1.1).Pearson correlation analysis showed that preoperative serum MDA,MPO and AOPPs were positively correlated with postoperative pain(r=0.421,0.371,0.486,all P<0.05).SOD,T-AOC and GSH-Px levels were negatively correlated with postoperative pain(r=-0.135,-0.176,-0.332,all P<0.05).Preoperative serum levels of IL-2,IL-6,IL-8,TNF-αand CRP were positively correlated with postoperative pain(r=0.426,0.411,0.548,0.223,0.302,all P<0.05).Conclusion The preoperative stress and inflammation are closely related to the postoperative pain of patients undergoing joint replacement surgery.The more severe the preoperative stress and inflammation,the more obvious the postoperative pain.