摘要
目的探讨髋关节置换术后老年患者自控镇痛对全身炎症反应综合征的发生及血清炎症性细胞因子的影响。方法选择2011年1月-2013年1月住院接受人工全髋关节置换术的老年患者52例,平均随机分为对照组与观察组,对照组采用术后肌内注射镇痛剂方式镇痛,观察组则采用术后硬膜外自控镇痛方式镇痛,观察并比较两组患者术后全身炎症反应综合征发生率;术前及术后血清C-反应蛋白、白细胞介素-6(IL-6)、IL-10以及肿瘤坏死因子-α(TNF-α)的水平。结果观察组术后全身炎症反应综合征发生率为7.69%,显著低于对照组的30.77%,差异有统计学意义(χ2=9.640,P<0.05);对照组患者术后3h及24h血清IL-6、TNF-α、CRP水平显著升高(P<0.05),TNF-α由(0.67±0.58)pg/ml上升至术后3h的(1.95±0.39)pg/ml以及术后24h的(1.89±0.24)pg/ml;IL-10水平较术前无显著变化(P>0.05);观察组患者术后3h及24h血清IL-6、TNF-α、CRP及IL-10水平均显著升高,差异有统计学意义(P<0.05),术后3h及24h,观察组患者血清CRP、IL-6及TNF-α水平均显著低于对照组,术后24h血清IL-10水平显著高于对照组,差异均有统计学意义(P<0.05)。结论硬膜外自控镇痛能够显著降低老年患者髋关节置换术后炎症水平,维持炎性细胞因子平衡,减少全身炎症反应综合征的发生。
OBJECTIVE To explore the effect of patient controlled analgesia （PCA） on the incidence of systemic inflammatory response syndrome （SIRS） and the serum inflammatory and serum inflammatory cytokines in the elderly patients after hip replacement surgery. METHODS Totally 52 cases of patients, who underwent hip replacement surgery in the hospital from Jan 2011 to Jan 2013, were enrolled in the study and were randomly divided into the control group and the observation group; the control group was treated for analgesia with intramuscular injection of analgesic agents, while the observation group was treated with the epidural patient controlled analgesia, then the incidence of postoperative SIRS and levels of serum C-reactive protein （CRP）, interleukin-6 （IL-6）, IL-10, and tumor necrosis factor-α（TNF-α） were observed and compared between the two groups. RESULTS The incidence rate of postoperative SIRS of the observation group was 7.69%, significantly lower than 30.77% of the control group, the difference was statistically significant （X2 = 9. 640, P〈0.05） ; the levels of serum IL-6, TNF-α, and CRP 3h or 24h after the surgery were elevated significantly in the control group （P〈0.05）, the level of TNF-α increased from （0.67±0.58）pg/ml to （1.95±0.39）pg/ml 3 h after the surgery and （1.89±0.24）pg/ml 24 h after the surgery, and the level of IL-10 showed no significant change （P〉0.05） ; the levels of serum IL-6, TNF-α, and CRP 3h or 24h after the surgery were elevated significantly, the difference was statistically significant （P〈0.05）. the levels of serum IL-6, TNF-α, and CRP 3h or 24h after the surgery were significantly lower in the observation groupthan in the control group, while the level of serum IL-10 24h after the surgery of the observation group was significantly higher than that of the control group, the differences were statistically significant （P〈0.05）. CONCLUSION The epidural PCA can significantly decrease the levels of inflammatory factors in the elderly patients after hip replacement surgery and maintain the balance of inflammatory cytokines as well as reduce the incidence of SIRS.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2013年第21期5188-5190,共3页
Chinese Journal of Nosocomiology
基金
浙江省中医药科技计划专项基金项目(2011ZA037)
关键词
自控镇痛
全身炎症反应综合征
老年患者
Patient controlled analgesia
Systemic inflammatory response syndrome
Elderly patient
