超声引导下髋关节囊周围神经阻滞对髋关节置换术患者疼痛介质与炎症应激反应的影响

Effect of Ultrasound-guided Pericapsular Nerve Group Block on Pain Mediators and Inflammatory Stress Response in Patients Undergoing Total Hip Arthroplasty

目的研究超声引导下髋关节囊周围神经阻滞(PENGB)对髋关节置换术(THA)患者疼痛介质与炎症应激反应的影响。方法以2021年1月-2023年1月新干县人民医院拟行THA治疗的52例患者为研究对象,行随机数字表法分为FICB组(26例)与PENGB组(26例)。FICB组采用超声引导下髂筋膜间隙阻滞(FICB)方案,PENGB组则选择超声引导下PENGB方案,比较两组围术期疼痛介质水平[前列腺素E_(2)(PGE_(2))、P物质(SP)]、炎症应激反应指标[白细胞介素-8(IL-8)、皮质醇(COR)、C-反应蛋白(CRP)]、术后镇痛效果[视觉模拟评分(VAS)]、术后股四头肌肌力。结果两组术中、术后PGE_(2)、SP水平均高于术前,但PENGB组术后PGE_(2)、SP水平低于FICB组(P<0.05);两组术后IL-8、COR、CRP水平高于术前,但PENGB组IL-8、COR、CRP水平低于FICB组(P<0.05);PENGB组术后1、6 h的VAS评分(静态、动态)均低于FICB组(P<0.05);PENGB组术后2、6、12 h股四头肌肌力评级高于FICB组(P<0.05)。结论超声引导下PENGB方案可改善THA患者的术后镇痛效果,下调其疼痛介质与炎症应激反应,促进术后四头肌肌力恢复。

Objective To study the effect of ultrasound-guided pericapsular nerve group block(PENGB)on pain mediators and inflammatory stress response in patients undergoing total hip arthroplasty(THA).Methods From January 2021 to January 2023,52 patients who were scheduled to undergo THA in Xingan County People's Hospital were selected as the research objects.They were divided into FICB group(26 patients)and PENGB group(26 patients)by random number table method.The FICB group was treated with ultrasound-guided fascia iliaca compartment block(FICB),while the PENGB group was treated with ultrasound-guided PENGB.The levels of perioperative pain mediators[prostaglandin E_(2)(PGE_(2)),substance P(SP)],inflammatory stress response indexes[interleukin-8(IL-8),cortisol(COR),C-reactive protein(CRP)],postoperative analgesic effect[Visual Analogue Scale(VAS)]and postoperative quadriceps muscle strength were compared between the two groups.Results The levels of PGE_(2) and SP in the two groups during and after operation were higher than those before operation,but the levels of PGE_(2) and SP in the PENGB group after operation were lower than those in the FICB group(P<0.05).The levels of IL-8,COR and CRP in the two groups after operation were higher than those before operation,but the levels of IL-8,COR and CRP in the PENGB group were lower than those in the FICB group(P<0.05).The VAS scores(static and dynamic)at 1 and 6 h after operation in the PENGB group were lower than those in the FICB group(P<0.05).The muscle strength rating of quadriceps femoris in PENGB group was higher than that in FICB group at 2,6 and 12 h after operation(P<0.05).Conclusion Ultrasound-guided PENGB regimen can improve the postoperative analgesic effect of THA patients,down-regulate their pain mediators and inflammatory stress response,and promote the recovery of quadriceps muscle strength after operation.