程序化多模式镇痛对老年髋部骨折手术患者脑氧代谢及Toll样受体表达的影响
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摘要
目的:探讨程序化多模式镇痛对老年髋部骨折手术患者脑氧代谢及Toll样受体表达的影响。方法:选择2015年1月至2016年12月新疆维吾尔自治区人民医院收治的136例老年髋部骨折患者为研究对象,随机分为对照组(采用术后多模式镇痛)及观察组(采用程序化多模式镇痛),每组68例。于术后1h、6h、24h、48h及72h,比较两组视觉模拟量表(VAS)评分,观察两组术前及术后1h、6h、24h动脉血氧含量(CaO_2)、颈内静脉球部血氧含量(Cj-vO_2)、动脉与颈内静脉血氧含量差(DavO_2)、脑氧摄取率(CERO_2)、肿瘤坏死因子-α(TNF-α)、白介素(IL)-1β、IL-6、Toll样受体2(TLR2)、TLR4变化。结果:术后,两组除CaO_2外,VAS评分、脑氧代谢指标(Cj-vO_2、Da-vO_2、CERO_2)、炎症指标(TNF-α、IL-1β、IL-6)及TLR2、TLR4表达均随着镇痛时间变化而产生波动,且多呈先升高后下降趋势,并以术后1h时变化最为明显,但与对照组相比,观察组各项指标波动幅度较小,两组比较差异均具有统计学意义(均P<0.05)。结论:程序化多模式镇痛有助于削弱手术及疼痛对脑氧代谢指标、炎症因子及Toll样受体表达的影响,从而为患者术后恢复提供有利条件。
Objective:To investigate the effects of programmed multimodal analgesia on cerebral oxygen metabolism and toll-like receptor(TLR)expression in elderly patients with hip fracture.Methods:One hundred and sixty-six elderly patients with hip fracture treated in our hospital from 2015 to 2016 were selected,and randomly divided into a control group(postoperative multimodal analgesia)and an observation group(procedural multimodal analgesia),with 68 cases in each group.The visual analogue scale(VAS)score,the arterial oxygen content(CaO_2),jugular venous oxygen content(Cj-vO_2),arterial-internal jugular venous oxygen content difference(Da-vO_2),cerebral ex-traction rate of oxygen(CERO_2),and the levels of tumor necrosis factor(TNF)-α,interleukin(IL)-1βand IL-6 in serum as well as the TLR2 and TLR4 expression were detected before and after operation.Results:After operation,except for CaO_2,the VAS score,the Cj-vO_2,Da-vO_2,CERO_2,and serum TNF-α,IL-1βand IL-6 levels as well as the positive expression rate of TLR2 and TLR4 were changed with the analgesic time prolonged,and the changes were more obvious in the control group than those in the observation group(P<0.05).These indexes were first increased then decreased,and the change was most significant at 1 hpostoperation.Conclusion:Programmed multimodal analgesia could help reduce the impact of surgery and pain on brain oxygen metabolism indicators,inflammatory factors and TLR expression,thereby providing good conditions for postoperative recovery.
Objective:To investigate the effects of programmed multimodal analgesia on cerebral oxygen metabolism and toll-like receptor(TLR)expression in elderly patients with hip fracture.Methods:One hundred and sixty-six elderly patients with hip fracture treated in our hospital from 2015 to 2016 were selected,and randomly divided into a control group(postoperative multimodal analgesia)and an observation group(procedural multimodal analgesia),with 68 cases in each group.The visual analogue scale(VAS)score,the arterial oxygen content(CaO_2),jugular venous oxygen content(Cj-vO_2),arterial-internal jugular venous oxygen content difference(Da-vO_2),cerebral ex-traction rate of oxygen(CERO_2),and the levels of tumor necrosis factor(TNF)-α,interleukin(IL)-1βand IL-6 in serum as well as the TLR2 and TLR4 expression were detected before and after operation.Results:After operation,except for CaO_2,the VAS score,the Cj-vO_2,Da-vO_2,CERO_2,and serum TNF-α,IL-1βand IL-6 levels as well as the positive expression rate of TLR2 and TLR4 were changed with the analgesic time prolonged,and the changes were more obvious in the control group than those in the observation group(P<0.05).These indexes were first increased then decreased,and the change was most significant at 1 hpostoperation.Conclusion:Programmed multimodal analgesia could help reduce the impact of surgery and pain on brain oxygen metabolism indicators,inflammatory factors and TLR expression,thereby providing good conditions for postoperative recovery.
引文
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[11]肖鹏冲,梅莉,王召军,等.帕瑞昔布对大鼠全脑缺血再灌注损伤中学习和记忆能力的保护作用[J].实用医学杂志,2014(24):3922-3925.
[12]CHOI B M,LEE S H,AN S M,et al.The time-course and RNA interference of TNF-α,IL-6,and IL-1βexpression on neuropathic pain induced by L5 spinal nerve transection in rats[J].Korean Journal of Anesthesiology,2015,68(2):159-169.
[13]LUAN H,ZHANG Q,WANG L,et al.OM85-BV induced the productions of IL-1β,IL-6,and TNF-αvia TLR4-and TLR2-mediated ERK1/2/NF-κB pathway in RAW264.7cells[J].Journal of Interferon&Cytokine Research,2014,34(7):526-536.
[14]程财清,任何,施镔,等.帕瑞昔布超前镇痛联合术后硬膜外镇痛应用于髋关节置换术患者的临床观察[J].中国药房,2017,28(11):1518-1522.
[15]ALBUQUERQUE A F M,FONTELES C S R,DO VAL D R,et al.Effect of pre-emptive analgesia on clinical parameters and tissue levels of TNF-αand IL-1βin third molar surgery:a triple-blind,randomized,placebocontrolled study[J].International Journal of Oral and Maxillofacial Surgery,2017,46(12):1615-1625.
[2]赵克聪,孙海燕,范静宇,等.规范化疼痛管理模式在老年髋部骨折手术患者中的应用效果[J].中国康复理论与实践,2017,23(7):848-850.
[3]王言武,孙岸灵.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[J].安徽医药,2015,19(5):974-977.
[4]李杰,杨继维,王国伟,等.镇痛镇静对急诊重症蛛网膜下腔出血患者脑氧代谢的影响[J].现代生物医学进展,2016,16(36):7168-7171.
[5]RIDDELL M,OSPINA M,HOLROYD-LEDUC J M.Use offemoral nerve blocks to manage hip fracture pain among older adults in the emergency department:a systematic review[J].Cjem,2016,18(4):245-252.
[6]孙梅杰,边雯,李慧禄,等.瑞芬太尼控制性降压对老年患者鼻内镜术后认知功能和脑氧代谢的影响[J].中国老年学杂志,2014,34(9):2358-2360.
[7]刘慧丽,张小青,李跃新,等.不同多模式镇痛策略对腹腔镜手术后疼痛的影响[J].临床麻醉学杂志,2014,30(3):235-238.
[8]周红社,霍红艳,廖华山,等.多模式镇痛用于骨科下肢术后镇痛的临床观察[J].实用临床医药杂志,2015,19(3):76-78.
[9]JOHNSEN B,NOHR K B,DUEZ C H V,et al.The nature of EEG reactivity to light,sound,and pain stimulation in neurosurgical comatose patients evaluated by a quantitative method[J].Clinical EEG and Neuroscience,2017,48(6):428-437.
[10]OKONKWO D O,SHUTTER L A,MOORE C,et al.Brain oxygen optimization in severe traumatic brain injury phase-Ⅱ:aphaseⅡrandomized trial[J].Critical Care Medicine,2017,45(11):1907-1914.
[11]肖鹏冲,梅莉,王召军,等.帕瑞昔布对大鼠全脑缺血再灌注损伤中学习和记忆能力的保护作用[J].实用医学杂志,2014(24):3922-3925.
[12]CHOI B M,LEE S H,AN S M,et al.The time-course and RNA interference of TNF-α,IL-6,and IL-1βexpression on neuropathic pain induced by L5 spinal nerve transection in rats[J].Korean Journal of Anesthesiology,2015,68(2):159-169.
[13]LUAN H,ZHANG Q,WANG L,et al.OM85-BV induced the productions of IL-1β,IL-6,and TNF-αvia TLR4-and TLR2-mediated ERK1/2/NF-κB pathway in RAW264.7cells[J].Journal of Interferon&Cytokine Research,2014,34(7):526-536.
[14]程财清,任何,施镔,等.帕瑞昔布超前镇痛联合术后硬膜外镇痛应用于髋关节置换术患者的临床观察[J].中国药房,2017,28(11):1518-1522.
[15]ALBUQUERQUE A F M,FONTELES C S R,DO VAL D R,et al.Effect of pre-emptive analgesia on clinical parameters and tissue levels of TNF-αand IL-1βin third molar surgery:a triple-blind,randomized,placebocontrolled study[J].International Journal of Oral and Maxillofacial Surgery,2017,46(12):1615-1625.