喉罩七氟烷联合臂丛神经阻滞在儿童上肢骨折手术中对炎症和应激水平的影响

Effect of laryngeal mask sevoflurane combined with brachial plexus nerve block on inflammation and stress levels in children patients with upper limb fracture surgery

目的探讨儿童上肢骨折手术中喉罩七氟烷联合臂丛神经阻滞对患儿炎症和应激水平的影响。方法选取该院2018-2019年因上肢骨折择期行手术治疗的患儿86例,根据麻醉方式不同分为对照组和联合组,每组43例。对照组仅接受喉罩七氟烷全身麻醉,联合组接受喉罩七氟烷全身麻醉联合臂丛神经阻滞麻醉。比较两组手术、麻醉及不良反应发生情况。采用视觉模拟评分法(VAS)评分评价患儿术后4 h、8 h及12 h疼痛程度。术前、术后当天及术后第3天,测定患儿血清中白细胞介素1β(IL^(-1)β)、白细胞介素10(IL^(-1)0)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)及胰岛素(Ins)水平。结果与对照组相比,联合组手术时间和苏醒时间短,疼痛出现时间晚,差异均有统计学意义(P<0.05)。术后4 h、8 h及12 h,联合组VAS评分均低于对照组,差异有统计学意义(P<0.05)。术后当天和术后第3天,联合组IL^(-1)β、IL^(-1)0、CRP、TNF-α、E、NE、Cor及Ins水平低于对照组,差异均有统计学意义(P<0.05)。结论喉罩七氟烷联合臂丛神经阻滞可应用于儿童上肢骨折手术,患儿苏醒快,不良反应发生率小,镇静、镇痛效果好,炎症和应激水平低。

Objective To explore the effect of laryngeal mask sevoflurane combined with brachial plexus nerve block on the levels of inflammation and stress in children patients with upper limb fracture surgery.Methods A total of 86 children patients with elective surgical treatment due to upper limb fracture in this hospital from January 2018 to December 2019 were selected and divided into the control group and combined group according to different anesthesia methods,43 cases in each group.The control group only received the general anesthesia with laryngeal mask sevoflurane,and the combined group received the laryngeal mask sevoflurane general anesthesia combined with brachial plexus nerve block anesthesia.The operation,anesthesia and adverse reactions occurrence were compared between the two groups.The Visual Analogue Scale(VAS)score was used to evaluate the pain degree of the children patients at 4,8,12h after surgery.The levels of serum interleukin-1β(IL^(-1)β),interleukin-10(IL^(-1)0),C-reactive protein(CRP),tumor necrosis factor(TNF-α),epinephrine(E),norepinephrine(NE),cortisol(Cor)and insulin(Ins)were measured before operation and on operation day,postoperative 3 d.Results Compared with the control group,the operative time and awakening time in the combined group were shorter,the onset time of pain appeared later,and the differences werestatistically significant(P<0.05).The VAS scores at postoperative 4,8,12 h in the combined group were lower than those in the control group,and the differences were statistically significant(P<0.05).On the operation day and postoperative 3 d,the levels of IL^(-1)β,IL^(-1)0,CRP,TNF-α,E,NE,Cor and Ins in the combined group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Laryngeal mask sevoflurane combined with brachial plexus nerve block can be applied in child upper limb fracture surgery.The children patients wake up quickly,and have small incidence rate of adverse reactions,good sedative and analgesic effects and low inflammatory and stress response levels.