超前镇痛联合多模式镇痛对股骨颈骨折患者免疫功能及细胞因子的影响

目的 探讨超前镇痛联合多模式镇痛对股骨颈骨折患者免疫功能及细胞因子的影响.方法 选取90例股骨颈骨折空心钉内固定术患者,依据随机数字表法分为A、B、C组,每组30例.A组患者采取超前镇痛,B组患者采取多模式镇痛,C组患者采取超前镇痛联合多模式镇痛,观察3组患者的镇痛效果疼痛视觉模拟评分法(VAS)]、睡眠评分、镇痛剂用量、免疫功能(CD+4、CD+8、CD+4/CD+8)、细胞因子白介素-6(IL-6)、IL-1β、肿瘤坏死因子-α(TNF-α)].结果 与A组比较,B组术后12、24 h的睡眠评分更低,C组术后12、24、48 h的睡眠评分明显更低,差异均有统计学意义(P<0.05).与B组比较,C组术后12、24、48 h的睡眠评分明显降低,差异有统计学意义(P<0.05).B、C组12、24 h睡眠评分低于A组,且比较差异有统计学意义,与A组比较,B组和C组的镇痛次数、镇痛剂量以及术后12 h、术后24 h、术后48 h的VAS评分、吗啡使用量、IL-6、IL-1β 和TNF-α 明显降低,差异有统计学意义(P<0.05).与B组相比,C组的镇痛次数、镇痛剂量以及术后12、24、48 h的VAS评分、吗啡使用量、IL-6、IL-1β 和TNF-α明显降低,差异有统计学意义(P<0.05).与A组比较,B组和C组术后12、24、48 h的CD+4、CD+8和CD+CD+8明显降低,差异有统计学意义(P<0.05).与B组比较,C组术后12、24、48 h的CD+4、CD+8和CD+4/CD+8明显降低,差异有统计学意义(P<0.05).结论 对于股骨颈骨折空心钉内固定术患者采取超前镇痛联合多模式镇痛可提供更有效的镇痛效果,减少麻醉性止痛剂用量,提高了患者的免疫功能.

Effects of preemptive analgesia combined with multimodal analgesia on immune function and cytokines of patients with femoral neck fracture

Objective To analyze the effects of preemptive analgesia combined with multimodality analgesia on immune function and cytokines of patients with femoral neck fracture. Methods Ninety patients with femoral neck fracture who received internal fixation with hollow nail in our hospital from January 2011 to September 2015 were divided into group A, group B and group C according to random number table,with 30 patients in each group. The patients in group A were treated by preemptive analgesia,and the patients in group B were treated by multimodality analgesia,however,the patients in group C were treated by preemptive analgesia combined with multimodality analgesia. The analgesic effects (VAS),sleeping scoring, analgesic agent dosage,immunity function indexes including CD +4 ,CD +8 ,CD +4 / CD +8 ,cytokines including interleukin-6 (IL-6),IL-1β,tumor necrosis factor-α (TNF-α) were observed and compared among the three groups. Results As compared with those in group A,the sleeping scores on 12h,24h after operation in group B and in group C on 12h,24h,48h after operation were significantly decreased (P < 0. 05). As compared with those in group B,the sleeping scores on 12h,24h, 48h after operation in group C were significantly decreased (P < 0. 05). Moreover the sleeping scores on 12h,24h after operation in group B and in group C were significantly lower than those in group A. As compared with those in group A,the analgesia number of times,analgesia dosage,VAS scores on 12h,24h,48h after operation,morphine dosage,the levels of IL-6, IL-1β and TNF-α on 12,24,48h after operation in group B and C were significantly decreased (P < 0. 05). As compared with those in group B,the analgesia number of times,analgesia dosage,VAS scores on 12,24,48h after operation,morphine dosage,the levels of IL-6,IL-1β and TNF-α on 12,24,48h after operation in group C were significantly decreased (P <0. 05). As compared with those in group A,the levels of CD +8 and CD +4 / CD +8 on 12,24,48h after operation in group B and group C were significantly decreased (P < 0. 05). As compared with those in group B,the levels of CD +4 ,CD +8 and CD +4 /CD +8 in group C were significantly decreased on 12,24,48h after operation (P < 0. 05). Conclusion The preemptive analgesia combined with multimodality analgesia has more effective analgesia effects in patients with femoral neck fracture who receive internal fixation with hollow nail,which can decrease the dosage of narcotic analgesics and improve the immune function of patients.