超前镇痛方案对跟骨关节内骨折患者OPG/RANKL信号通路因子表达的影响

Effects of Preemptive Analgesia on the Expression of OPG/RANKL Signaling Pathway Factors in Patients with Calcaneal Intra-articular Fractures

目的:探讨超前镇痛方案对跟骨关节内骨折患者骨保护素(osteoprotegerin,OPG)/核因子-κB受体活化因子配基(receptor activator of nuclear factor-κB ligand,RANKL)信号通路因子表达的影响。方法:选择2019年2月-2021年11月在南京中医药大学附属苏州市中医医院诊治的跟骨关节内骨折患者74例,按照入院顺序,根据1∶1随机数字表法把患者分为超前组与对照组各37例。所有患者给予切开复位内固定治疗,对照组给予常规静脉自控镇痛(patient controlled intravenousanalgesia,PCIA),超前组在对照组镇痛的基础上给予术前30 min静注地佐辛超前镇痛。记录两组围手术指标;术前、术后1、2、3、7 d的疼痛状况;两组不良反应发生情况;术后1、7 d检测血清OPG、RANKL含量。结果:超前组的术后引流量、术后引流时间与术后住院时间均少于对照组(P<0.05)。超前组术后1、2、3、7 d的疼痛VAS评分均少于对照组(P<0.05)。超前组术后7 d的恶心呕吐、寒战、延迟苏醒等并发症发生率为8.1%,低于对照组的32.4%(P<0.05)。两组术后7 d的血清OPG、RANKL含量均高于术后1 d(P<0.05),超前组也均高于对照组(P<0.05)。结论:超前镇痛方案应用在跟骨关节内骨折患者中能促进OPG/RANKL信号通路因子表达,能提高镇痛效果,促进患者术后康复,还可减少患者术后并发症的发生。

Objective:To investigate the effect of preemptive analgesia on the expression of OPG/RANKL signaling pathway factors in patients with calcaneal intra-articular fractures.Method:A total of 74 patients with intra-articular fractures of the calcaneus who were diagnosed and treated in Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine from February 2019 to November 2021 were selected.According to the order of admission,the patients were divided into the advanced group and the control group according to the 1∶1 random number table method,with 37 cases in each.All patients were treated with open reduction and internal fixation,the control group was given routine patient controlled intravenous analgesia(PCIA),and the advanced group was given intravenous Dezocine preoperative analgesia 30 minutes before surgery on the basis of intravenous analgesia in the control group.The perioperative indicators of the two groups;the pain status before and 1,2,3,7 d after operation;the occurrence of adverse reactions in the two groups;serum OPG and RANKL levels on the 1 and 7 days after surgery were recorded.Result:The postoperative drainage volume,postoperative drainage time and postoperative hospital stay of the advanced group were less than those of the control group(P<0.05).The VAS scores of pain in the advanced group at 1,2,3,7 d after operation were lower than those in the control group(P<0.05).The incidence of complications such as nausea,vomiting,chills and delayed awakening in the advanced group was 8.1%at 7 days after operation,which was lower than 32.4%in the control group(P<0.05).The serum levels of OPG and RANKL in the two groups at 7 days after operation were higher than those at 1 day after operation(P<0.05),and the advanced group were also higher than those in the control group(P<0.05).Conclusion:The application of preemptive analgesia in patients with calcaneal intra-articular fractures can promote the expression of OPG/RANKL signaling pathway factors,improve the analgesic effect,promote postoperative recovery,and reduce postoperative complications.