多模式镇痛对下肢骨折患者术后疼痛、炎性因子及免疫功能的影响

目的：探讨多模式镇痛（MMA）对下肢骨折患者术后疼痛和炎性因子的影响。方法120例下肢骨折患者，随机均分为对照组（C组）、MMA Ⅰ组、MMA Ⅱ组、MMA Ⅲ组。C组不给镇痛，Ⅰ组仅术前给予氟比洛芬酯（经静脉）和舒芬太尼（经硬膜外），Ⅱ组术后给药，Ⅲ组术前和术后均给药。记录术后6、12、24 h VAS评分和术前、术后24、72 h白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平和外周血CD4＋／CD8＋、CD25＋比例、NK细胞（CD3－CD16＋CD56＋）比例。结果 MMA Ⅰ组、MMA Ⅱ组、MMAⅢ组术后12、24 h VAS评分明显低于C组（P＜0．05）；MMA Ⅲ组术后24 h VAS评分显著低于MMA Ⅰ组、MMA Ⅱ组（P＜0．05）。MMAⅠ组、MMAⅡ组、MMAⅢ组术后24、72 h IL-6和TNF-α浓度明显低于C组（P＜0．05），MMAⅠ组、MMA Ⅱ组显著高于MMA Ⅲ组（P＜0．05）；术后24、72 h MMAⅠ组、MMA Ⅱ组、MMA Ⅲ组IL-6和TNF-α浓度明显高于C组（P＜0．05）；MMA Ⅰ组和MMA Ⅲ组CD4＋／CD8＋术后72 h恢复到术前水平（P＞0．05）。MMA Ⅲ组NK细胞术后72 h恢复到术前水平，无统计学差异（P＞0．05）。术后24 h血清IL-6、TNF-α水平和外周血CD4＋／CD8＋、NK细胞水平均呈负相关关系（P＜0．05）。而术后72 h血清炎性因子和外周免疫细胞相关性不明显。结论 MMA有效改善下肢骨折患者术后疼痛，减轻炎性反应。

Influence of multi-modal analgesia on postoperative inflammatory cytokines and immune cells in patients with lower limb fractures

Objective To investigate the influence of multi-modal analgesia on postoperative pain and inflammatory cytokines in pa-tients with lower limb fractures.Methods 120 patients with lower limb fractures were randomly divided into control group (group C), MMA Ⅰgroup,MMA Ⅱgroup,and MMAⅢgroup.Group C didn’t receive analgesia;group I received analgesia using lurbiprofen ax-etil (intravenous)and sufentanil (through epidural)preoperatively;MMA Ⅱ received analgesia postoperatively;MMA Ⅲgroup re-ceived both preoperatively and postoperatively.VAS scores were recorded at 6,12,and 24 h after surgery,and the concentrations of in-terleukin-6 (IL-6)and tumor necrosis factor-α(TNF-α)were also recorded at postoperative 24 h and72 h.Results VAS scores at postoperative 12 h and24 h in groups MMA Ⅰ,MMA Ⅱ and MMA Ⅲwere significantly lower than those in group C (P <0.05);VAS scores at postoperative 24h in group MMA Ⅲwere significantly lower than that in groups MMA Ⅰand MMA Ⅱ(P <0.05).The concentrations of IL-6 and TNF-αat postoperative 24 and 72 h in groups MMAⅠ,MMAⅡand MMAⅢ were significantly lower than those in group C (P <0.05),and the concentrations of IL-6 and TNF-αat postoperative 72h in groups MMA Ⅰ and MMA Ⅱ were significantly higher than those in group MMA Ⅲ(P <0.05).CD4 +/CD8 +in MMAⅠ and MMAⅢ groups recovered to preoperative levels in 72h (P>0.05).NK cells in MMAⅢgroup recovered to preoperative levels in 72h (P>0.05).There was negative correlation among IL-6,TNF-α,CD4 +/CD8 +and NK cells(P <0.05)24h after the surger-y,but there was not obvious correlation among them 72h after the surgery.Conclusions Multi-modal analgesia effectively im-proved postoperative pain and reduced inflammation in patients with lower limb fracture.