目的:研究多模式镇痛+超前镇痛对老年髋关节置换患者术后恢复的影响,观察其对患者术后疼痛相关神经递质、炎症因子及应激反应的影响。方法:选择在我院接受髋关节置换术的老年患者并随机分为超前镇痛组、多模式镇痛组、联合镇痛组。手术前及手术后6、24 h,检测血清中疼痛相关神经递质、炎症因子及应激反应分子的含量。结果:三组患者手术后6、24 h血清中SP、PGE2、NO、5-HT、ICAM-1、hs-CRP、IL-6、IL-10、Cor、NE、MDA的含量均显著高于手术前且联合镇痛组患者手术后6、24 h血清中SP、PGE2、NO、5-HT、ICAM-1、hs-CRP、IL-6、IL-10、Cor、NE、MDA的含量均显著低于超前镇痛组及多模式镇痛组。结论:多模式镇痛+超前镇痛用于老年髋关节置换术能够较多模式镇痛及超前镇痛单用更为有效地减轻术后疼痛及炎症反应、应激反应,利于患者恢复。

Objective: To study the effect of multimodal analgesia + preemptive analgesia on the postoperative recovery of elderly patients with hip replacement, and observe its effect on the postoperative pain-related neurotransmitters, inflammatory factors and stress response. Methods: Elderly patients who received hip replacement in the hospital between February 2015 and December 2016 were selected and randomly divided into preemptive analgesia group, multimodal analgesia group and combined analgesia group. Serum levels of pain-related neurotransmitters, inflammatory factors and stress response molecules were detected before surgery as well as 6 hours and 24 hours after surgery. Results:Serum SP, PGE2, NO, 5-HT, ICAM-1, hs-CRP, IL-6, IL-10, Cor, NE and MDA levels of three groups of patients 6 hours and 24 hours after surgery were significantly higher than those before surgery, and serum SP, PGE2, NO, 5-HT, ICAM-1, hs-CRP, IL-6, IL-10, Cor, NE and MDA levels of combined analgesia group 6 hours and 24 hours after surgery were significantly lower than those of preemptive analgesia group and multimodal analgesia group. Conclusion: Multimodal analgesia + preemptive analgesia can be more effective than multimodal analgesia and preemptive analgesia in reducing postoperative pain, inflammatory response and stress response in elderly patients with hip replacement.

R687.4

四川省医学会青年创新课题(Q15036)