摘要
目的探讨小儿上肢骨折手术采用臂丛神经阻滞复合全身麻醉的应激反应。方法回顾性选取滕州市中心人民医院于2020年3月—2023年3月诊治的120例上肢骨折患儿的临床资料,按照不同麻醉方法将患儿分为参考组(n=60)和研究组(n=60)。参考组实施全身麻醉,研究组予以臂丛神经阻滞复合全身麻醉,比较两组血流动力学指标、应激反应和炎症因子水平。结果参考组与研究组T0(麻醉前)心率以及平均动脉压对比,差异无统计学意义(P均>0.05);T1(置入喉罩时)、T2(拔除喉罩时)时研究组心率以及平均动脉压低于参照组,差异有统计学意义(P均<0.05)。参考组与研究组术前5 min应激反应指标对比,差异无统计学意义(P>0.05);术后6h,研究组皮质醇、肾上腺素和去甲肾上腺素水平低于参考组,差异有统计学意义(P均<0.05)。术前参考组与研究组炎症因子水平对比,差异无统计学意义(P>0.05);术后3 d,研究组的肿瘤坏死因子-α(26.01±5.34)ng/L、C反应蛋白(8.71±1.25)mg/L和白介素-1β(2.03±0.34)ng/L低于参考组,差异有统计学意义(t=12.865、11.849、18.676,P均<0.05)。结论臂丛神经阻滞复合全身麻醉可以降低患儿的应激反应,炎症反应较小,同时血流动力学水平波动较小。
Objective To investigate the stress response of brachial plexus block combined with general anesthesia in children with upper limb fracture surgery.Methods Clinical data of 120 children with upper limb fractures diagnosed and treated in Tengzhou Central People's Hospital from March 2020 to March 2023 were retrospectively selected.The children were divided into reference group(n=60)and study group(n=60)according to different anesthesia meth-ods.The reference group was given general anesthesia,and the study group was given brachial plexus block combined with general anesthesia.The hemodynamic indexes,stress response and inflammatory factor levels were compared be-tween the two groups.Results There were no significant differences in heart rate and mean arterial pressure between the reference group and the study group at T0(before anaesthetic)(both P>0.05).At T1(When placing a laryngeal mask)and T2(When removing a laryngeal mask),the level of heart rate and mean arterial pressure in the study group were smaller than those in the reference group,and the differences were statistically significant(all P<0.05).There was no significant difference in stress response index between the reference group and the study group at 5 min before operation(P>0.05).The level of cortisol,epinephrine and norepinephrine in the study group were lower than those in the reference group at 6 h after operation,and the differences were statistically significant(all P<0.05).There were no significant differences in the levels of inflammatory factors between the reference group and the study group before op-eration(all P>0.05).The changes of tumor necrosis factor-α(26.01±5.34)ng/L,C-reactive protein(8.71±1.25)mg/L and interleukin-1β(2.03±0.34)ng/L in the study group were lower than those in the reference group at 3 days after operation,and the differences were statistically significant(t=12.865,11.849,18.676,all P<0.05).Conclusion Bra-chial plexus block combined with general anesthesia can reduce the stress response,less inflammatory reaction,and less hemodynamic level fluctuation.
作者
屈文慧
裴亚丽
董庆永
QU Wenhui;PEI Yali;DONG Qingyong(Department of Anesthesiology,Tengzhou Central People's Hospital,Tengzhou,Shandong Province,277500 China)
出处
《系统医学》
2024年第10期154-157,共4页
Systems Medicine
关键词
小儿上肢骨折
臂丛神经阻滞
全身麻醉
应激反应
炎症因子
Upper limb fracture in children
Brachial plexus block
General anesthesia
Stress response
Inflammatory factor
