不同镇痛方式对胫腓骨骨折患者切开复位内固定术后炎性因子平衡的影响

摘要

Objective To investigate the influence of different analgesia methods on the balance of plasma inflammatory cytokines postoperatively in patients with tibial and fibular fracture undergoing open reduction and internal fixation under lumbar epidural anesthesia.Methods Four hundred patients with tibial and fibular fracture were randomly divided into parecoxib + tramadol analgesia group(group P + T),patient controlled epidural analgesia (PCEA) group(PCEA group) and patient controlled intravenous analgesia(PCIA) group(PCIA group).Visual analogue scale(VAS) were measured 24-48 hours after operation.Venous blood samples were taken before anesthesia(T1),5 minute after skin incision(T2),at the end of operation(T3) and 24-48 hours after operation for determination of the ratio of serum interleukin-6 (IL-6) and IL-10.Results There was no statistical significance among the three groups while comparing VAS 24-48 hours after operation or the ratio of IL-6/IL-10 at T1,T2 and T3 (P ＞ 0.05).While the ratio of IL-6/IL-10 compared among the three groups 24-48 hours after operation,group PCEAwas (4.1±3.0),group P+T was (7.8 ±4.5) and PCIA group was (10.9 ±8.6) (P＜0.01).Conclusion To reduce inflammation caused by trauma and operation,PCEA is the most favorable method due to the lowest influence on the balance of plasma inflammatory cytokines while parecoxib + tramadol analgesia is the second followed by PCIA in patients with tibial and fibular fracture postoperatively.%目的 探讨不同镇痛方式对胫腓骨闭合性骨折患者切开复位内固定术后血中炎性因子平衡的影响.方法 将400例胫腓骨闭合性骨折患者按随机数字表法随机分为帕瑞昔布+曲马多镇痛组(P+T组)、患者自控硬膜外镇痛(PCEA)组和患者自控静脉镇痛(PCIA)组,观察3组患者术后24～48 h的疼痛视觉模拟评分(VAS评分);测定3组麻醉前、切皮后5 min、手术结束时以及术后24 ～ 48 h血浆白细胞介素6(IL-6)、IL-10比值.结果 3组术后24～48 h VAS评分差异无统计学意义(P＞0.05).3组IL-6/IL-10比值在麻醉前、切皮后5 min、手术结束各时点比较,差异无统计学意义(P＞0.05);术后24～48 h PCEA组IL-6/IL-10为(4.1±3.0),P+T组为(7.8±4.5),PCIA组为(10.9±8.6),3组间两两比较差异均有统计学意义(均P＜0.01).结论 帕瑞昔布+曲马多镇痛、PCEA、PCIA 3种镇痛方式中,PCEA对胫腓骨闭合性骨折患者切开复位内固定术后炎性因子平衡的影响最小,最有利于减轻炎症反应,其次为帕瑞昔布+曲马多镇痛.