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

Effect of preemptive analgesia regimen on OPG/RANKL signaling pathway factor expression in patients with intra-articular calcaneal fracture

目的 探讨跟骨关节内骨折患者采用超前镇痛方案对骨保护素(OPG)/核因子-κB受体活化因子配体(RANKL)信号通路因子表达的影响。方法 回顾性选取2017年2月至2022年2月大庆油田总医院收治的跟骨关节内骨折患者100例,依据镇痛方案不同分为对照组和观察组,每组各50例。对照组患者接受常规性静脉自控镇痛方案,观察组患者接受地佐辛超前镇痛联合常规性静脉自控镇痛方案。统计分析两组围手术期指标(术中出血量、手术时间、术后引流量、术后引流时间、住院时间),麻醉前、手术前、手术后即刻的血流动力学(平均动脉压、心率),手术前、手术后1 d的应激反应[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、前列腺素E2(PGE2)],手术后即刻,手术后6 h、12 h、1 d的镇静[Ramsay镇静评分(RSS)、视觉模拟评分法(VAS)评分]和镇痛效果,以及手术后1 d、手术后1周的血清OPG、RANKL含量和术后并发症发生情况。结果 两组患者的术中出血量、手术时间比较,差异均无统计学意义(P>0.05);观察组患者的术后引流量为(59.86±2.54) mL,少于对照组[(110.97±9.41) mL],术后引流时间、住院时间分别为(123.23±9.82) h、(5.61±0.45) d,均短于对照组[(178.22±9.32) h、(8.01±0.31) d],差异均有统计学意义(P<0.05)。麻醉前、手术前、手术后即刻,两组患者的平均动脉压、心率比较差异均无统计学意义(P>0.05)。手术后1 d,两组患者的血清CRP、TNF-α、IL-6、PGE2水平均明显高于手术前,观察组患者的血清CRP、TNF-α、IL-6、PGE2水平分别为(5.11±1.47) mg/L、(43.15±7.51)μg/L、(32.52±5.31) ng/L、(138.11±12.68) pg/mL,均明显低于对照组[(21.42±3.44) mg/L、(87.60±13.56)μg/L、(75.77±21.35) ng/L、(144.60±15.20) pg/mL],差异均有统计学意义(P<0.05)。与手术后即刻比较,两组患者手术后6、12、24 h的RSS评分、VAS评分均逐渐降低,差异均有统计学意义(P<0.05);手术后6、12、24 h,两组患者的RSS评分、VAS评分比较差异均无统计学意义(P>0.05)。手术后1周,两组患者的血清OPG、RANKL含量均高于手术后1 d,且观察组患者的血清OPG、RANKL含量分别为(188.86±21.47)、(108.37±10.43) pg/mL,均高于对照组[(177.75±19.23)、(98.76±8.26) pg/mL],差异均有统计学意义(P<0.05)。观察组患者的术后并发症发生率为8.00%,明显低于对照组(32.00%),差异有统计学意义(P<0.05)。结论 超前镇痛方案能够促进跟骨关节内骨折患者OPG/RANKL信号通路因子表达及患者术后康复,提高镇痛效果,减少术后并发症的发生。

Objective To investigate the effect of preemptive analgesia on the expression of osteoprotegerin(OPG)/receptor activator of nuclear factor-κB ligand(RANKL) signaling pathway factors in patients with intra-articular fracture of calcaneal bone.Methods A total of 100 patients with intra-articular fracture of root bone in Daqing Oilfield General Hospital from February 2017 to February 2022 were retrospectively selected,and patients were divided into two groups according to the analgesia regimen:the control group and the observation group,with 50 cases in each group.The control group received routine intravenous patient-controlled analgesia,while the observation group received a combination of dexamethasone preemptive analgesia and routine intravenous patient-controlled analgesia.The perioperative indicators(intraoperative bleeding volume,surgical time,postoperative drainage volume,postoperative drainage time,hospital stay),hemodynamics(mean arterial pressure,heart rate) before anesthesia,before surgery,and immediately after surgery,stress response [C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),prostaglandin E2(PGE2) before surgery,1 day after surgery,sedation[Ramsay sedation score(RSS),visual analog scale(VAS) score]and analgesic effect at immediately after surgery,6 hours,12 hours,1 day after surgery,serum OPG,RANKL levels at 1 day,1 week after surgery,and incidence of postoperative complications of the two groups were statistically analyzed.Results There were no statistically significant differences in intraoperative bleeding volume and surgical time between the two groups of patients(P>0.05);the postoperative drainage volume of the observation group patients was(59.86±2.54) mL,which was lower than that of the control group [110.97±9.41) mL],the postoperative drainage time and hospital stay were(123.23±9.82) h and(5.61±0.45) d,respectively,which were shorter than those of the control group [178.22±9.32) h and(8.01±0.31) d],and the differences were statistically significant(P<0.05).There were no statistically significant differences in mean arterial pressure and heart rate between the two groups before anesthesia,before operation and immediately after operation(P>0.05).At 1 day after surgery,the levels of serum CRP,TNF-α,IL-6,and PGE2 in the two groups of patients were significantly higher than those before surgery,and the levels of serum CRP,TNF-α,IL-6,and PGE2 in the observation group were(5.11±1.47) mg/L,(43.15±7.51) μg/L,(32.52±5.31) ng/L,and(138.11±12.68) pg/mL,respectively,which were significantly lower than those in the control group [(21.42±3.44) mg/L,(87.60±13.56)] μg/L,(75.77±21.35) ng/L,(144.60±15.20) pg/mL],the differences were statistically significant(P<0.05).The RSS scores and VAS scores of the two groups of patients at 6,12,and 24 hours after surgery were lower than those at immediately after surgery,and the differences were statistically significant(P<0.05);at 6,12 and 24 h after surgery,there were no statistically significant differences in RSS scores and VAS scores between the two groups(P>0.05).At 1 week after surgery,the levels of serum OPG and RANKL in two groups of patients were higher than those at 1 day after surgery,and the levels of serum OPG and RANKL in the observation group were(188.86±21.47) and(108.37±10.43) pg/mL,respectively,which were higher than those in the control group [(177.75±19.23) and(98.76±8.26) pg/mL],the differences were statistically significant(P<0.05).The incidence of postoperative complications in the observation group was 8.00%,which was significantly lower than that in the control group(32.00%),the difference was statistically significant(P<0.05).Conclusion The advanced analgesic plan can promote the expression of OPG/RANKL signaling pathway factors in patients with intra-articular calcaneal fractures and postoperative rehabilitation,improve the analgesic effect,and reduce the occurrence of postoperative complications.