【摘要】 目的探讨连续股神经阻滞与静脉自控镇痛对全膝关节置换术后镇痛效果及对Th1/Th2水平的影响。方法选择2017年5月至2018年5月佛山市中医院行全膝关节置换术治疗患者160例。根据入院先后顺序,将患者分为两组,对照组术后采用静脉自控镇痛,研究组采用连续股神经阻滞镇痛。对比两组视觉模拟评分(visual analogue score,VAS)、凝血功能指标、外周血神经生长因子(nerve growth factor, NGF)、脑源性神经营养因子(brain-derived neurotrophic factor, BDNF)水平变化及Th1细胞、Th2细胞、Th1/Th2水平。结果两组术后48 h静态、动态VAS评分比较差异无统计学意义(P>0.05);研究组术后12 h、24 h静态、动态VAS评分均显著低于对照组(P<0.05);研究组术后1 h、24 h、48 h的凝血反应时间(R)、血凝块形成时间(K)明显长于对照组,血凝块最大振幅(maximun blood clot amplitude, MA)水平明显低于对照组(P<0.05),术后1 h、24 h、48 h的血BDNF及NGF水平均高于对照组(P<0.05);术后1 h、24 h,两组Th1、Th1/Th2较麻醉前明显下降,Th2均明显上升,且对照组改变幅度明显高于研究组(P<0.05)。结论连续股神经阻滞镇痛对行全膝关节置换术患者的术后镇痛效果显著,可有效改善患者的凝血功能和外周血BDNF、NGF水平,并维持Th1/Th2的平衡。更多还原

【Abstract】 Objective To investigate the effects of continuous femoral nerve block and intravenous controlled analgesia on analgesia and Th1/Th2 levels after total knee arthroplasty. Methods A total of 160 patients who underwent total knee arthroplasty in our hospital from May 2017 to May 2018 were randomly divided into two groups according to admission order. The control group was treated with intravenous analgesia, and the study group was treated with continuous femoral nerve block analgesia. The visual analogue scale(VAS), coagulation function index, peripheral blood nerve growth factor(NGF),brain-derived neurotrophic factor(BDNF) level and Th1 cell, Th2 cell, Th1/Th2 levels were compared between the two groups. Results There was no difference in static and dynamic VAS scores between the two groups at 48 hours after operation(P>0.05). However, the static and dynamic VAS scores of the study group were significantly lower than those of the control group at 12 and 24 hours after operation(P<0.05). The levels of coagulation reaction time(R), blood clot formation time(K) in the study group were significantly higher than those in the control group at one, 24 and 48 hours after operation, and the maximum blood clot amplitude(MA) level was significantly lower than that of the control group(P<0.05). The blood levels of BDNF and NGF in the study group were higher than those in the control group at one, 24 and 48 hours after operation(P<0.05). After surgery for one and 24 hours, the Th1 and Th1/Th2 of the patients in two groups decreased significantly compared with those before anesthesia, while Th2 increased significantly, and the change amplitude of the control group was significantly higher than that of the study group(P<0.05). Conclusions Continuous femoral nerve block has significant analgesic effects in patients undergoing total knee arthroplasty. The method can effectively improve the coagulation function of patients and the levels of BDNF and NGF in peripheral blood, and maintain the balance of Th1/Th2.更多还原