关键词: 骨折；麻醉和镇痛；内皮, 血管

Abstract: Objective  To investigate the effects of two anesthesia strategies on postoperative analgesia, inflammatory response and vascular endothelial function in patients with lower extremity fracture. 
Methods  A total of 86 patients with lower extremity fracture who underwent open internal fixation were selected. According to different anesthesia strategies, they were divided into intravenous general anesthesia group(n=43) and combined spinal epidural anesthesia group(n=43). In general anesthesia group, propofol+sufentanil strategy was used, and 0.75% ropivacaine + sufentanil strategy was used in combined spinal epidural anesthesia group. The anesthetic effects of the two groups were compared. Before anesthesia(T0), immediately after operation(T1), at 6 h after operation(T2), 24 h after operation(T3) and 72 h after operation(T4), changes in pain scores, inflammatory factors and vascular endothelial function factors were compared. 
Results  The anesthesia effect of the combined anesthesia group(grade Ⅲ: 86.02%) was significantly better than that of the general anesthesia group(grade Ⅲ: 60.47%), and the difference was statistically significant(P＜0.05). At T1-T4, the visual analogy score(VAS) of the two groups showed a progressive decrease whereas vascular endothelial growth factor(VEGF) showed a progressive increase(P＜0.05). However, the VAS of the combined anesthesia group was lower, and VEGF was higher, as compared with those of the general anesthesia group(P＜0.05). The levels of tumor necrosis factor α(TNF-α), interleukin-6(IL-6), hypersensitive C reactive protein(hs CRP), VEGF, compound F,(FC), and angiotensin Ⅱ（AngⅡ）in the two groups were increased from T1 to T3, and began to decrease after reaching the highest level at T2, and decreased at T4, which were lower than those at T0(P＜0.05), while the levels of TNF-α, IL-6, hs-CRP, FC, and AngⅡ in the combined anesthesia group were lower than those in the general anesthesia group at T1-T4(P＜0.05). 
Conclusion  Both intravenous general anesthesia and combined spinal and epidural anesthesia have good anesthetic effects. However, compared with intravenous general anesthesia, the effect of combined spinal and epidural anesthesia is more significant in improving postoperative analgesia, reducing postoperative inflammatory response and improving vascular endothelial function.

Key words: bone fractures, anesthesia and analgesia, endothelium, vascular