鸡尾酒疗法对全髋关节置换术后切口局部炎性因子的影响

Effect of cocktail therapy on local inflammatory factors of incision after total hip arthroplasty

目的探讨鸡尾酒疗法对全髋关节置换术(THA)后早期切口局部炎性因子的影响。方法选择2019年6月至2020年12月在岳阳市人民医院诊断为老年股骨颈骨折将行单侧、初次THA的61例患者,根据随机数表法分为鸡尾酒疗法组31例和对照组30例。鸡尾酒疗法组于术中假体安放完成后,在髋关节前后关节囊、周围肌肉、深筋膜及皮下等部位局部注射鸡尾酒药物60 ml,对照组不予局部注射。测量两组患者术后1、4、7、24 h的切口引流液样本中C反应蛋白(CRP)、白细胞介素-6(IL-6)及血清淀粉样蛋白A(SAA)的水平。两组间比较采用t检验;若不满足,则使用Wilcoxon秩和检验比较。分类变量组间差异比较采用χ2检验。结果THA术后1、4、7、24 h的切口引流液样本中CRP、SAA、IL-6水平,鸡尾酒疗法组与对照组数据对比如下,CRP:(3.79±1.39)mg/L比(10.53±1.52)mg/L(t=18.089,P<0.05)、(6.32±3.12)mg/L比(14.78±2.79)mg/L(t=11.156,P<0.05)、(11.10±3.79)mg/L比(18.60±1.26)mg/L(t=10.433,P<0.05)、(30.13±5.28)mg/L比(38.82±5.70)mg/L(t=6.183,P<0.05);IL-6:(4.59±1.51)mg/L比(7.12±1.15)mg/L(t=7.326,P<0.05)、(7.13±1.74)mg/L比(9.94±2.71)mg/L(t=4.793,P<0.05)、(17.35±2.62)mg/L比(20.83±2.57)mg/L(t=5.228,P<0.05)、(13.31±3.62)mg/L比(15.24±3.10)mg/L(t=2.229,P<0.05);SAA:(4.94±0.98)mg/L比(5.89±0.89)mg/L(t=3.957,P<0.05)、(6.15±1.21)mg/L比(7.84±2.60)mg/L(t=3.233,P<0.05)、(6.56±1.78)mg/L比(9.28±2.91)mg/L(t=4.376,P<0.05)、(25.15±3.22)mg/L比(27.20±4.29)mg/L(t=2.106,P<0.05)。与对照组比较,鸡尾酒疗法组CRP、SAA、IL-6水平均低于对照组,差异有统计学意义(P<0.05)。结论鸡尾酒疗法可以一定程度降低THA术后早期切口引流液中CRP、SAA、IL-6的水平。

Objective To investigate the effect of cocktail therapy on local inflammatory factors in early incision after total hip arthroplasty(THA).Methods Totally,61 elderly patients with femoral neck fracture diagnosed in Yueyang People’s Hospital from June 2019 to December 2020 undergoing unilateral and initial THA were randomly divided into cocktail therapy group(31 cases)and control group(30 cases).After the prosthesis was placed in the cocktail therapy group,60 ml cocktail drug was injected locally into the anterior and posterior joint capsule,surrounding muscles,deep fascia and subcutaneous parts of the hip joint,while the control group was not injected locally.The levels of C-reactive protein(CRP),interleukin-6(IL-6)and serum amyloid A(SAA)in incision drainage fluid samples were determined at 1,4,7 and 24 h after operation.T-test was used for comparison between the two groups;If not,Wilcoxon rank sum test was used for comparison.Chi square test was used to compare the differences between groups in categorical variables.Results The levels of CRP,SAA and IL-6 in incision drainage fluid samples at 1,4,7 and 24 h after THA were compared between cocktail therapy group and control group as follows:for CRP,(3.79±1.39)mg/L vs.(10.53±1.52)mg/L(t=18.089,P<0.05),(6.32±3.12)mg/L vs.(14.78±2.79)mg/L(t=11.156,P<0.05),(11.10±3.79)mg/L vs.(18.60±1.26)mg/L(t=10.433,P<0.05),(30.13±5.28)mg/L vs.(38.82±5.70)mg/L(t=6.183,P<0.05);for IL-6,(4.59±1.51)mg/L vs.(7.12±1.15)mg/L(t=7.326,P<0.05),(7.13±1.74)mg/L vs.(9.94±2.71)mg/L(t=4.793,P<0.05),(17.35±2.62)mg/L vs.(20.83±2.57)mg/L(t=5.228,P<0.05),(13.31±3.62)mg/L vs.(15.24±3.10)mg/L(t=2.229,P<0.05);for SAA,(4.94±0.98)mg/L vs.(5.89±0.89)mg/L(t=3.957,P<0.05),(6.15±1.21)mg/L vs.(7.84±2.60)mg/L(t=3.233,P<0.05),(6.56±1.78)mg/L vs.(9.28±2.91)mg/L(t=4.376,P<0.05),(25.15±3.22)mg/L vs.(27.20±4.29)mg/L(t=2.106,P<0.05).Compared with the control group,CRP,SAA and IL-6 levels in the cocktail therapy group were significantly reduced(P<0.05).Conclusion Cocktail therapy can reduce the levels of CRP,SAA and IL-6 in early incision drainage fluid after THA to a certain extent.