多模式镇痛对骨科手术后认知功能及CPR、Cor、IL-10的影响

doi:10.3969/j.issn.1671-2587.2019.06.025

临床输血与检验 ›› 2019, Vol. 21 ›› Issue (6): 649-653.DOI: 10.3969/j.issn.1671-2587.2019.06.025

多模式镇痛对骨科手术后认知功能及CPR、Cor、IL-10的影响

蔡可庆, 王立伟, 宦乡

221000 江苏省徐州市中心医院

收稿日期:2017-12-29 出版日期:2019-12-20 发布日期:2019-12-25
作者简介:蔡可庆（1987-）,女,江苏徐州人,医师,硕士,主要从事麻醉学研究工作,（Tel）18112000390。

Impact of Multimodal Analgesia on the Postoperative Cognitive Function and Concentrations of CPR,Cor and IL-10 in Orthopedics

CAI Ke-qing, WANG Li-wei, HUAN Xiang

The Central Hospital of Xuzhou,Jiangsu 221000

Received:2017-12-29 Online:2019-12-20 Published:2019-12-25

摘要/Abstract

摘要： 目的研究多模式镇痛对骨科手术后的认知功能及对C反应蛋白（CPR）、血浆皮质醇（Cor）、白细胞介素（IL-10）水平的影响。方法收集2015年3月~2017年3月本院的100例骨科患者,根据术后镇痛方法不同分为对照组（n=50例）和实验组（n=50例）。对照组采用常规硬膜外镇痛,0.2 mg芬太尼、1 g曲马多、5 mg氟哌利多,与生理盐水混合成100 mL。观察组采用多模式镇痛,口服400 mg塞来昔布,术中采用300 mg罗哌卡因、40 mg甲基强的松龙、0.5 mL肾上腺素,加入生理盐水至100 mL,术后采用常规硬膜外镇痛。观察两组手术时间、术中失血量、术中尿量、POCD发生率,血清CPR、Cor、IL-10水平,VAS、MMSE评分,不良反应发生率。结果两组手术时间、术中失血量、术中尿量的差异均无统计学意义（P>0.05）,实验组POCD发生率低于对照组（P<0.05）;实验组CPR、Cor水平在术后1 h、48 h低于对照组（P<0.05）,两组IL-10水平的差异无统计学意义（P>0.05）;实验组VAS评分低于对照组（P<0.05）,MMSE评分高于对照组（P<0.05）;实验组不良反应发生率低于对照组（P<0.05）。结论多模式镇痛对骨科手术后镇痛效果显著,能够减少认知功能障碍的发生率,降低炎症因子的表达,减少并发症,有利于早期功能锻炼。

关键词: 多模式镇痛, 骨科手术, 认知功能障碍, C反应蛋白, 白细胞介素, 血浆皮质醇

Abstract: Objective To reveal the influence of multimodal analgesia on postoperative cognitive dysfunction and C reactive protein （CPR）,plasma cortisol （Cor）,and IL-10 in orthopedics. Methods One hundred patients were divided into two groups,with 50 in each. The control group was treated with routine epidural analgesia,including 0.2 mg fentanyl,1.0 g tramadol,and 5.0 mg droperidol,mixed with physiological saline in total volume of 100 mL,while the experiment group were given multimodal analgesia,including 400 mg oral Celebrex,with 300 mg ropivacaine,40 mg methylprednisolone,5.0 mg Maca,and 0.5mL epinephrine,adding normal saline to 100 mL. The operation time,blood loss,intraoperative urine volume,POCD incidence,serum CPR,Cor,IL-10,VAS and MMSE score,adverse reactions rate in the two groups were examined and observed. Results No significant difference of operation time,intraoperative blood loss and intraoperative urine volume was noted between the two groups（P>0.05）. The incidence of POCD in the experiment group was significantly lower than that in the control（P<0.05）. The levels of CPR and Cor at 1h and 48h after operation were decreased compared with those of the control（P<0.05）. The IL-10 concentration remained unchanged in the two groups（P>0.05）.The VAS score was decreased（P<0.05） but MMSE score,increased（P<0.05）with less adverse reactions compared to the control（P<0.05）. Conclusion Multimodal analgesia has a remarkable therapeutic role in postoperative analgesia of the orthopedics patients by reducing the incidence of cognitive dysfunction,the expression of inflammatory factors,and complications.

Key words: Multimodal analgesia, Orthopedic surgery, Cognitive dysfunction, C reactive protein, Interleukin-10, Plasma cortisol

中图分类号:

蔡可庆, 王立伟, 宦乡. 多模式镇痛对骨科手术后认知功能及CPR、Cor、IL-10的影响[J]. 临床输血与检验, 2019, 21(6): 649-653.

CAI Ke-qing, WANG Li-wei, HUAN Xiang. Impact of Multimodal Analgesia on the Postoperative Cognitive Function and Concentrations of CPR,Cor and IL-10 in Orthopedics[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2019, 21(6): 649-653.

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多模式镇痛对骨科手术后认知功能及CPR、Cor、IL-10的影响

Impact of Multimodal Analgesia on the Postoperative Cognitive Function and Concentrations of CPR,Cor and IL-10 in Orthopedics

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