發(fā)布時間：2018-01-27 06:06

  本文關(guān)鍵詞： 多模式鎮(zhèn)痛 下肢骨折 疼痛 免疫功能 細(xì)胞因子　出處：《蘇州大學(xué)》2015年博士論文　論文類型：學(xué)位論文

【摘要】：目的:下肢骨折患者不僅承受骨折造成的痛苦,而且術(shù)后深受切口疼痛、患肢腫脹和限制活動等困擾。組織損傷、手術(shù)創(chuàng)傷、疼痛等導(dǎo)致細(xì)胞因子大量釋放,在產(chǎn)生炎癥反應(yīng)的同時,也誘發(fā)中樞和外周疼痛敏化,加重疼痛,而且疼痛抑制機(jī)體的免疫功能,不利病情康復(fù)�？茖W(xué)、有效的鎮(zhèn)痛能保護(hù)機(jī)體的免疫功能和抑制炎性反應(yīng),目前,多模式鎮(zhèn)痛是臨床普遍應(yīng)用的鎮(zhèn)痛模式,但尚無統(tǒng)一標(biāo)準(zhǔn)。因此,本研究探討多模式鎮(zhèn)痛對下肢骨折患者術(shù)后疼痛、免疫功能和細(xì)胞因子的影響,為臨床鎮(zhèn)痛提供參考。方法:100例ASAI~II級在腰硬聯(lián)合麻醉下行下肢骨折切開復(fù)位內(nèi)固定術(shù)患者,隨機(jī)均分為對照組(C組,術(shù)前靜脈注射生理鹽水10ml,硬膜外腔注射生理鹽水6ml,術(shù)畢靜脈注射生理鹽水10ml,硬膜外腔注射生理鹽水6ml。)、多模式鎮(zhèn)痛I組(MMA I組,術(shù)前靜脈注射氟比洛芬酯100mg,硬膜外腔注射舒芬太尼0.3μg/kg,術(shù)畢靜脈注射生理鹽水10ml,硬膜外腔注射生理鹽水6ml。)、多模式鎮(zhèn)痛II組(MMA II組,術(shù)前靜脈注射生理鹽水10ml,硬膜外腔注射生理鹽水6ml,術(shù)畢靜脈注射氟比洛芬酯100mg,硬膜外腔注射舒芬太尼0.3μg/kg。)、多模式鎮(zhèn)痛III組(MMA III組,術(shù)前靜脈注射氟比洛芬酯50mg,硬膜外腔注射舒芬太尼0.15μg/kg,術(shù)畢靜脈注射氟比洛芬酯50mg,硬膜外腔注射舒芬太尼0.15μg/kg。)。四組舒芬太尼均用生理鹽水稀釋至6ml,術(shù)后均行芬太尼自控靜脈鎮(zhèn)痛。記錄術(shù)后6h、8h、12h、24h、48h VAS評分和術(shù)后24h芬太尼需要量、哌替啶需要次數(shù),觀察不良反應(yīng)。比較術(shù)前、術(shù)后24h、48h CD4+、CD8+和CD4+/CD8+變化。記錄術(shù)前、術(shù)后24h、48h白細(xì)胞介素-6(IL-6)和腫瘤壞死因子-a(TNF-α)濃度。結(jié)果:⑴術(shù)后12h、24h、48h VAS評分,MMA I組、MMA II組、MMA III組明顯低于C組(P0.05);術(shù)后24h、48h VAS評分,MMA III組明顯低于MMA I組、MMA II組(P0.05)。術(shù)后24h芬太尼需要量,MMA I組、MMA II組、MMA III組明顯少于C組(P0.05),且MMA III組芬太尼需要量顯著少于MMA I組、MMA II組(P0.05)。四組術(shù)后24h哌替啶需要次數(shù)和不良反應(yīng)比較差異無統(tǒng)計學(xué)意義(P0.05)。⑵術(shù)前,MMA I組、MMA II組、MMA III組和C組CD4+、CD8+和CD4+/CD8+比較差異無統(tǒng)計學(xué)意義(P0.05);術(shù)后24h、48h,MMA I組、MMA II組、MMA III組CD4+和CD4+/CD8+明顯高于C組(P0.05),而MMA III組顯著高于MMA I組、MMA II組(P0.05)。⑶術(shù)前,MMA I組、MMA II組、MMA III組和C組IL-6和TNF-α濃度比較差異無統(tǒng)計學(xué)意義(P0.05);術(shù)后24h、48h,MMA I組、MMA II組、MMA III組IL-6和TNF-α濃度明顯低于C組(P0.05),而MMA I組、MMA II組IL-6和TNF-α濃度顯著高于MMA III組(P0.05)。結(jié)論:術(shù)前靜脈注射氟比洛芬酯50mg+術(shù)前硬膜外腔注射舒芬太尼0.15μg/kg+術(shù)畢靜脈注射氟比洛芬酯50mg+術(shù)畢硬膜外腔注射舒芬太尼0.15μg/kg,術(shù)后聯(lián)合芬太尼自控靜脈鎮(zhèn)痛,這種多模式鎮(zhèn)痛更能有效減輕下肢骨折患者的術(shù)后疼痛,改善免疫功能,減輕炎性反應(yīng)。
[Abstract]:Objective: the patients with lower extremity fracture not only suffer from the pain caused by fracture, but also suffer from incision pain, swelling of the affected limb and restriction of movement. Tissue injury, surgical trauma, pain and so on lead to the release of cytokines. In the production of inflammatory reactions, but also induced central and peripheral pain sensitization, aggravated pain, and pain inhibits the immune function of the body, adverse to the recovery of the disease. Effective analgesia can protect the immune function and inhibit inflammatory response. At present, multi-mode analgesia is widely used in clinical analgesia, but there is no unified standard. This study was designed to investigate the effects of multimode analgesia on postoperative pain, immune function and cytokines in patients with lower extremity fracture. Methods one hundred ASAI~II patients with lower extremity fracture treated by open reduction and internal fixation under spinal-epidural anesthesia were randomly divided into control group (group C) and control group (group C). Before operation, 10 ml of saline was injected intravenously, 6 ml of saline was injected into epidural cavity, 10 ml of saline was injected intravenously after operation, and 6 ml of saline was injected into epidural cavity. Before operation, flurbiprofen ester 100mg was injected intravenously, sufentanil 0.3 渭 g / kg was injected into epidural cavity, and normal saline 10ml was injected intravenously at the end of operation. 6 ml saline was injected into epidural cavity, and 10 ml saline was injected intravenously before operation in MMA II group, and 6 ml saline was injected into epidural cavity. After operation, flurbiprofen ester 100mg was injected intravenously, and sufentanil 0.3 渭 g / kg 路L 路L 路L 路L was injected into epidural cavity. The multimode analgesia III group was treated with MMA III. Before operation, flurbiprofen ester 50 mg, sufentanil 0.15 渭 g / kg, flurbiprofen 50 mg respectively. Sufentanil was injected into epidural cavity with 0.15 渭 g 路kg 路L sufentanil. Sufentanil was diluted to 6 ml with normal saline in all the four groups. Postoperative patient-controlled intravenous analgesia was performed with fentanyl. The adverse reactions were observed at 24 h, 48 h VAS score, 24 h fentanyl requirement, and 24 h pethidine requirement, and the adverse reactions were compared before and 24 h after operation for 48 h. The changes of CD8 and CD4 / CD8 were recorded before and 24 hours after operation. Results the concentration of interleukin-6 (IL-6) and TNF- 偽 (TNF- 偽) were measured at 48 h. Results the VAS scores were assessed at 24 h and 48 h after 1: 1 operation in MMAI group. MMA III in MMA II group was significantly lower than that in C group (P 0.05). The VAS score was significantly lower in the MMA III group than in the MMA I group at 24 and 48 hours after operation (P 0.05), and the fentanyl requirement at 24 hours after operation was significantly lower in the MMA III group than in the MMA I group. The content of fentanyl in group MMA II was significantly lower than that in group C (P 0.05), and the fentanyl requirement in group MMA III was significantly lower than that in group MMA I. There was no significant difference in the number of pethidine needs and adverse reactions between the four groups 24 hours after operation. There was no significant difference in CD4 CD8 and CD4 / CD8 between MMA III group and C group in MMA II group (P 0.05). CD4 and CD4 / CD8 in MMA III group were significantly higher than those in C group (P 0.05). However, MMA III group was significantly higher than MMA I group (P 0.05). There was no significant difference in the concentration of IL-6 and TNF- 偽 between MMA III group and C group (P 0.05). The concentrations of IL-6 and TNF- 偽 in MMA III group were significantly lower than those in C group (P 0.05) and MMA I group (P < 0.05). The concentrations of IL-6 and TNF- 偽 in MMA II group were significantly higher than those in MMA III group (P 0.05). Conclusion: 50 mg flurbiprofen ester was injected intravenously before operation by epidural injection of sufentanil 0.15 渭 g / kg, 50 mg flurbiprofen ester was injected intravenously after operation. At the end of operation, sufentanil was injected into epidural cavity with 0.15 渭 g / kg sufentanil. Postoperative patient-controlled intravenous analgesia combined with fentanyl, this multi-mode analgesia can effectively relieve postoperative pain, improve immune function and alleviate inflammatory reaction in patients with lower extremity fracture.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R614

【參考文獻(xiàn)】

相關(guān)期刊論文 前8條

1 張麗榮;孫德峰;;舒芬硬膜外術(shù)后鎮(zhèn)痛對免疫系統(tǒng)保護(hù)作用的觀察[J];大連醫(yī)科大學(xué)學(xué)報;2012年03期

2 歐陽文博;張坤全;左艷琴;冼國明;梁建群;盧先卿;;開胸圍術(shù)期應(yīng)用多模式鎮(zhèn)痛對術(shù)后鎮(zhèn)痛及鎮(zhèn)靜效果的影響[J];白求恩醫(yī)學(xué)雜志;2014年05期

3 朱旭;張星火;劉亮;趙峰;成文浩;張亞奎;郭艾;;全膝關(guān)節(jié)置換術(shù)后多模式鎮(zhèn)痛的臨床研究[J];中國骨與關(guān)節(jié)損傷雜志;2015年02期

4 王云;岳云;;術(shù)后疼痛分子機(jī)理研究進(jìn)展[J];中國繼續(xù)醫(yī)學(xué)教育;2011年10期

5 常潘;張瑞芹;;氟比洛芬酯抗炎及免疫保護(hù)研究進(jìn)展[J];中華實(shí)用診斷與治療雜志;2013年10期

6 胡彥艷;秦丹丹;葉鳳青;黃中華;黃愛蘭;馬利;藍(lán)嬌;;舒芬太尼復(fù)合氟比洛芬酯PCIA對老年肺癌根治術(shù)患者細(xì)胞免疫功能的影響[J];臨床麻醉學(xué)雜志;2013年10期

7 劉慧麗;張小青;李躍新;李楠;郭向陽;;不同多模式鎮(zhèn)痛策略對腹腔鏡手術(shù)后疼痛的影響[J];臨床麻醉學(xué)雜志;2014年03期

8 蔡淑女;方軍;蔡昀芳;;不同麻醉方式對肝癌患者圍手術(shù)期免疫功能的影響[J];中華全科醫(yī)學(xué);2014年10期

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