多模式镇痛效果及对下肢骨折患者免疫功能和细胞因子的影响-麻醉学专业论文.docxVIP

II II 中文摘要 多模式镇痛效果及对下肢骨折患者免疫功能和细胞因子的影响 组(P0.05)。术后 24h 芬太尼需要量，MMA I 组、MMA II 组、MMA III 组明显少于 C 组 (P0.05)，且 MMA III 组芬太尼需要量显著少于 MMA I 组、MMA II 组(P0.05)。 四组术后 24h 哌替啶需要次数和不良反应比较差异无统计学意义(P0.05)。 ⑵术前，MMA I 组、MMA II 组、MMA III 组和 C 组 CD4+、CD8+和 CD4+/CD8+比 较差异无统计学意义(P0.05)；术后 24h、48h，MMA I 组、MMA II 组、MMA III 组 CD4+和 CD4+/CD8+明显高于 C 组(P0.05)，而 MMA III 组显著高于 MMA I 组、MMA II 组(P0.05)。 ⑶术前，MMA I 组、MMA II 组、MMA III 组和 C 组 IL-6 和 TNF-α 浓度比较差异无 统计学意义(P0.05)；术后 24h、48h ，MMA I 组、MMA II 组、MMA III 组 IL-6 和 TNF-α 浓度明显低于 C 组(P0.05)，而 MMA I 组、MMA II 组 IL-6 和 TNF-α 浓度显 著高于 MMA III 组(P0.05)。 结论：术前静脉注射氟比洛芬酯 50mg+术前硬膜外腔注射舒芬太尼 0.15μg/kg+术毕静 脉注射氟比洛芬酯 50mg+术毕硬膜外腔注射舒芬太尼 0.15μg/kg，术后联合芬太尼自 控静脉镇痛，这种多模式镇痛更能有效减轻下肢骨折患者的术后疼痛，改善免疫功能， 减轻炎性反应。 关键词：多模式镇痛；下肢骨折；疼痛；免疫功能；细胞因子 作 者：温来友 指导老师：杨建平教授 PAGE PAGE IV 多模式镇痛效果及对下肢骨折患者免疫功能和细胞因子的影响 英文摘要 The effects of multimodal analgesia and the effects of multimodal analgesia on immune function and cytokine in patients with lower limb fracture Abstract Objective Patients with lower limb fracture not only suffered pain caused by fractures and surgical incision, but alse suffered postoperative limb swelling and restricted activity and other problems.Surgical stimulation and pain caused massive release of inflammatory cytokines, while inflammatory cytokines also induced central and peripheral sensitization of pain,increased pain, and pain also inhibited the bodys immune function, althoμgh analgesic could relieve suppression of immune function, but analgesic drμg itself could inhibit immune function. This study investigated the effects of multimodal analgesia and the effects of multimodal analgesia on immune function and cytokines in patients with lower limb fracture. Method 100 cases of patients with lower limb fracture, ASAI~II level,undergoing lumbar-epidural anesthesia for open reduction and internal fixation,were randomly divided into the control group (group C, preoperative intravenous saline 10ml,epidural saline 6ml,postoperative intravenous injecti