病房行神经阻滞加术后PCIA对老年骨科患者围手术期疼痛程度及疼痛介质、应激状态的影响研究

Study on the effect of nerve block in ward and postoperative PCIA on pain degree,pain mediators and stress state of elderly orthopedic patients during perioperative period

目的研究及观察病房行神经阻滞加术后静脉自控镇痛(patient controlled intravenous analgesia,PCIA)对老年骨科患者围手术期疼痛程度及疼痛介质、应激状态的影响。方法选取90例老年骨科手术患者为研究对象,将其随机分为A组(术后PCIA组)、B组(“鸡尾酒”局部注射镇痛加PCIA组)及C组(病房行神经阻滞加术后PCIA组),每组各30例。比较3组的术后2 h、4 h、6 h、12 h、24 h及48 h的VAS评分、入院时及术后12 h及48 h血清疼痛介质及应激状态(应激激素及氧化应激)指标。结果术后2 h、4 h、6 h、12 h、24 h及48 h 3组的VAS评分先升后降,且C组的VAS评分显著低于A组及B组,B组则显著低于A组,差异有统计学意义(P<0.05),入院时3组的血清疼痛介质及应激状态指标比较,差异无统计学意义(P>0.05),术后12 h及48 h 3组的血清疼痛介质及应激激素均先升后降,且C组的血清疼痛介质及应激激素指标显著低于A组及B组,B组则显著低于A组;入院时、术后12 h及48 h 3组的血清疼痛介质及应激激素均先降后升,且C组的血清氧化应激激素指标显著高于A组及B组,B组则显著高于A组,差异有统计学意义(P<0.05)。结论病房行神经阻滞加术后PCIA可显著控制老年骨科患者围手术期疼痛程度,且对疼痛介质及应激状态的影响相对更好,因此在老年骨科手术患者中的应用价值更高。

Objective To study and observe the effect of nerve block in ward and postoperative patient controlled intravenous analgesia(PCIA)on pain degree,pain mediators and stress state of elderly orthopedic patients during perioperative period.Methods A total of 90 elderly orthopedic patients were selected as the research subjects,and they were randomly divided into group A(postoperative PCIA group),group B(“Cocktail”local injection analgesia and PCIA group)and group C(nerve block in ward and postoperative PCIA group),with 30 cases in each group.Then the visual analogue scale(VAS)score at 2 h,4 h,6 h,12 h,24 h and 48 h after operation,serum pain mediators and stress state(stress hormones and oxidative stress)indexes at admission and at 12 h,48 h after operation of three groups were compared.Results The VAS scores of three groups at 2 h,4 h,6 h,12 h,24 h and 48 h after operation increased initially and decreased afterwards,and the VAS scores of group C were significantly lower than those of group A and group B,and the scores of group B were significantly lower than those of group A,suggesting significant differences(P<0.05).There was no significant difference in the serum pain mediators and stress state indexes of three groups(P>0.05).The serum pain mediators and stress hormones of three groups at 12 h and 48 h after operation increased initially and decreased afterwards;the serum pain mediators and stress hormone indexes of group C were all significantly lower than those of group A and group B,and the results of group B were significantly lower than those of group A.The serum pain mediators and stress hormones of three groups at 12 h and 48 h after operation increased initially and decreased afterwards;serum oxidative stress indexes of group C were all significantly higher than those of group A and group B,and the results of group B were significantly higher than those of group A,with significant differences(P<0.05).Conclusion The nerve block in ward and postoperative PCIA can effectively control the pain degree of elderly orthopedic patients during perioperative period,and its influence on pain mediators and stress state are relatively better.Therefore,its application value is higher in elderly patients undergoing orthopedic surgery.