Zhao Yong, Zhang Huiwen, Song Miaomiao
Department of Orthopedic, Shanghai Fengxian District Central Hospital, Shanghai 201400, China.
Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan 750002, China.
J Healthc Eng. 2022 Apr 7;2022:9510669. doi: 10.1155/2022/9510669. eCollection 2022.
To observe the postoperative pain control and clinical efficacy of ultrasound-guided nerve block anesthesia for patients with tibial fracture. A total of 128 patients with tibial fracture who received surgical treatment in our hospital from October 2020 to April 2021 were selected. The ultrasound guided anesthesia group and general anesthesia group were established by random number table method, with 64 patients in each group. Patients in the ultrasound-guided anesthesia group received ultrasound-guided nerve block anesthesia, and patients in the general anesthesia group received conventional general anesthesia. Observation times anesthetic effect in both groups, changes in hemodynamic parameters, digital pain scale (NRS) score as a result, compared two groups of patients with adverse reactions occur, change of the serum inflammatory factors indicators before and after operation, and USES the Pearson correlation coefficient analysis of the correlation between serum levels of inflammatory factor index and NRS score. The effect of anesthesia, postoperative recovery, directional force recovery, motor block and sensory block time of patients in ultrasound-guided anesthesia group decreased significantly than those in general anesthesia group (all < 0.05). The comparison of MAP, HR and RR at T1 and T2 levels between the two groups was statistically significant (all < 0.05). The changes of MAP, HR and RR in ultrasound guided anesthesia group were more stable than those in general anesthesia group.The NRS scores of patients in both groups showed an increasing trend with the extension of time. The 6 h, 12 h and 24 hNRS scores of patients in the ultrasound guided anesthesia group decreased significantly than those in the general anesthesia group (all < 0.05). The total incidence of adverse reactions in ultrasound guided anesthesia group decreased significantly than that in general anesthesia group ( < 0.05).The serum levels of inflammatory factor interleukin-6 (IL-6) and tumor necrosis factor- (TNF-) in 2 groups increased significantly before surgery, and the levels of each index in ultrasound guided anesthesia group decreased significantly than that in general anesthesia group (ALL < 0.05). Pearson correlation coefficient showed that serum IL-6 and TNF- levels were positively correlated with NRS score (all < 0.05). Ultrasound-guided nerve block anesthesia surgery can effectively improve the tibia fracture patients intraoperative anesthetic effect, improve patients with intraoperative and postoperative hemodynamic index of stability, the anesthesia surgery will exert positive effects on patients with postoperative pain control, can reduce the risk in patients with postoperative adverse reactions, reduce the postoperative patients with inflammatory factor activity. In addition, this paper found significant positive correlation between serum inflammatory factors IL-6 and TNF- and NRF score, suggesting that serum IL-6 and TNF- can be monitored for postoperative pain control in patients with tibial fracture, providing reference for improving postoperative treatment plan of patients.
观察超声引导下神经阻滞麻醉用于胫骨骨折患者的术后疼痛控制情况及临床疗效。选取2020年10月至2021年4月在我院接受手术治疗的128例胫骨骨折患者。采用随机数字表法分为超声引导麻醉组和全身麻醉组,每组64例。超声引导麻醉组患者接受超声引导下神经阻滞麻醉,全身麻醉组患者接受传统全身麻醉。观察两组患者的麻醉效果、血流动力学参数变化、数字疼痛量表(NRS)评分,比较两组患者不良反应发生情况、手术前后血清炎症因子指标变化,并采用Pearson相关系数分析血清炎症因子指标水平与NRS评分之间的相关性。超声引导麻醉组患者的麻醉效果、术后恢复、定向力恢复、运动阻滞及感觉阻滞时间均明显低于全身麻醉组(均P<0.05)。两组患者T1、T2水平MAP、HR、RR比较,差异有统计学意义(均P<0.05)。超声引导麻醉组MAP、HR、RR变化较全身麻醉组更稳定。两组患者NRS评分均随时间延长呈上升趋势。超声引导麻醉组患者术后6 h、12 h、24 h的NRS评分明显低于全身麻醉组(均P<0.05)。超声引导麻醉组不良反应总发生率明显低于全身麻醉组(P<0.05)。两组患者术前血清炎症因子白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平均明显升高,超声引导麻醉组各指标水平明显低于全身麻醉组(均P<0.05)。Pearson相关系数显示,血清IL-6、TNF-α水平与NRS评分呈正相关(均P<0.05)。超声引导下神经阻滞麻醉术可有效提高胫骨骨折患者术中麻醉效果,提高患者术中及术后血流动力学指标稳定性;该麻醉术对患者术后疼痛控制有积极作用,可降低患者术后不良反应发生风险,降低术后患者炎症因子活性。此外,本文发现血清炎症因子IL-6、TNF-α与NRS评分呈显著正相关,提示可通过监测血清IL-6、TNF-α水平对胫骨骨折患者进行术后疼痛控制,为完善患者术后治疗方案提供参考。