不同剂量罗哌卡因联合利多卡因腰硬联合麻醉对老年骨科患者细胞免疫功能及血流动力学的影响

发布时间：2018-04-21 00:12

本文选题：罗哌卡因 + 利多卡因　；参考：《中国老年学杂志》2017年24期

【摘要】：目的探讨不同剂量罗哌卡因联合利多卡因腰硬联合麻醉对老年骨科患者细胞免疫功能及血流动力学的影响。方法选取老年骨科患者86例,采用随机数字表法分为两组,43例患者实施0.50%罗哌卡因(剂量10 mg)+1%利多卡因(2 ml)腰硬联合麻醉为对照组,43例患者实施0.75%罗哌卡因(剂量15 mg)+1%利多卡因(2 ml)腰硬联合麻醉为观察组,比较两组不同时点细胞免疫功能及血流动力学指标的改变情况、感觉阻滞效果、运动阻滞效果和不良反应情况。结果两组CD3~+、CD4~+、CD4~+/CD8~+、自然杀伤(NK)细胞数量在T1时显著降低,在T3时降至最低点,在T4时明显升高。观察组CD3~+、CD4~+、CD4~+/CD8~+、NK细胞数量在T1、T2、T3、T4时均明显高于对照组。两组心率、平均动脉压在Ta时显著降低,在Tc时降至最低点,在Td时恢复正常。两组中心静脉压在Ta时显著升高,在Tc时升至最高点,在Td时恢复正常。观察组心率、平均动脉压在Ta、Tb、Tc时均明显高于对照组,中心静脉压在Ta、Tb、Tc时均明显低于对照组。观察组感觉阻滞起效时间、最高平面出现时间、运动阻滞起效时间均明显早于对照组,观察组最高平面维持时间、运动阻滞维持时间均明显长于对照组,观察组改良Bromage评分明显高于对照组,观察组不良反应发生率明显低于对照组(P0.05)。结论 0.75%罗哌卡因(剂量15 mg)+1%利多卡因(2 ml)腰硬联合麻醉对老年骨科患者细胞免疫功能及血流动力学的影响较小,麻醉起效快且维持时间长,不良反应少且安全性高。
[Abstract]:Objective to investigate the effects of different doses of ropivacaine combined with lidocaine on cellular immune function and hemodynamics in elderly orthopaedic patients. Methods 86 cases of senile orthopedic patients were selected. 43 patients with ropivacaine (10 mg) 1% lidocaine (2 ml) were divided into two groups by random digital table method. Combined spinal-epidural anesthesia with 0. 50% ropivacaine (10 mg) 1% lidocaine (2 ml) was given to 43 patients in the control group with 0. 75% ropivacaine (15 mg) and 1% lidocaine 2 ml. Combined anesthesia as observation group, The changes of cellular immune function and hemodynamic indexes, sensory block effect, motor block effect and adverse reaction were compared between the two groups at different time points. Results in both groups, the number of NK cells decreased significantly at T1, reached the lowest at T3 and increased significantly at T4. The number of NK cells in the observation group was significantly higher than that in the control group at T _ (1) T _ (2) T _ (2) and T _ (3) T _ (4). Heart rate and mean arterial pressure in both groups decreased significantly at Ta, reached the lowest at Tc and returned to normal at TD. The central venous pressure in both groups increased significantly at Ta, reached the highest point at Tc and returned to normal at TD. The heart rate and mean arterial pressure in the observation group were significantly higher than those in the control group at TbTc, and the central venous pressure at TbTc was significantly lower in the observation group than that in the control group. The onset time of sensory block, the onset time of the highest level and the onset time of motor block in the observation group were significantly earlier than those in the control group, and the maintenance time of the highest level and motor block in the observation group were significantly longer than those in the control group. The modified Bromage score in the observation group was significantly higher than that in the control group, and the incidence of adverse reactions in the observation group was significantly lower than that in the control group (P 0.05). Conclusion combined spinal-epidural anesthesia with 0.75% ropivacaine (15 mg) 1% lidocaine (2 ml) has little effect on cellular immune function and hemodynamics in elderly patients with orthopaedics.
【作者单位】：苏州市第七人民医院骨科;
【基金】：苏州市“科教兴卫”青年科技项目(KJXW2014062)
【分类号】：R614

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