硬膜外麻醉及腰硬联合麻醉对骨水泥半髋置换术老年患者免疫功能及激素水平的影响

发布时间：2018-07-03 09:03

本文选题：硬膜外麻醉 + 腰硬联合麻醉　；参考：《中国老年学杂志》2016年09期

【摘要】：目的比较硬膜外麻醉及腰硬联合麻醉对骨水泥半髋置换术老年患者免疫功能及激素水平的影响。方法择期行骨水泥半髋关节置换术的60例老年患者随机分为A组和B组,分别硬膜外麻醉和腰硬联合麻醉后进行骨水泥半髋置换术。比较两组术中出血量、输液量和输血量及手术时间,分别于麻醉前(T0)、骨水泥注入前(T1)、骨水泥注入时(T2)、手术结束时(T3)、术后24 h(T4)和术后48 h(T5)抽取血样测定两组血清激素水平和免疫细胞水平。结果 1两组术中出血量、输液量、输血量和手术时间差异均无统计学意义(P0.05);2B组CD4+和CD4+/CD8+在T1、T2、T3和T4时均较A组显著降低(P0.05或P0.01),CD8+均较A组显著升高(P0.01);3B组T1、T2、T3、T4和T5时皮质醇(Cor)、去甲肾上腺素(NE)和肾上腺素(Adr)水平显著低于A组(P0.01)。结论老年骨水泥半髋置换术患者采用腰硬联合麻醉较硬膜外麻醉对免疫细胞及激素水平影响较小,利于术后恢复。
[Abstract]:Objective to compare the effects of epidural anesthesia and combined spinal-epidural anesthesia on immune function and hormone level in elderly patients undergoing bone cement hemiarthroplasty. Methods Sixty elderly patients undergoing bone cement hemihip replacement were randomly divided into two groups: group A and group B. After epidural anesthesia and combined spinal-epidural anesthesia, bone cement semi-hip replacement was performed. The amount of blood loss, transfusion, blood transfusion and operation time were compared between the two groups. Before anesthesia (T 0), before bone cement injection (T 1), during bone cement injection (T 2), at the end of operation (T 3), 24 h after operation (T 4) and 48 h after operation (T 5), the serum hormone level and immune cell level were measured. Results 1Intraoperative blood loss and transfusion volume in the two groups; There was no significant difference in blood transfusion volume and operation time (P0.05). CD4 and CD4 / CD8 in group B were significantly lower than those in group A (P0.05 or P0.01). CD8 was significantly higher in group B than in group A (P0.01). The levels of T1T2T2T3T4 and T5 cortisol (Cor), norepinephrine (NE) and epinephrine (Adr) in group B were significantly higher than those in group A (P0.01). The level was significantly lower than that in group A (P0.01). Conclusion the effect of combined spinal-epidural anesthesia on immune cells and hormone levels in elderly patients with bone cement hemihip replacement is less than that of epidural anesthesia, which is beneficial to postoperative recovery.
【作者单位】：四川省人民医院城东病区麻醉科;奥斯迪康骨医院麻醉科;
【基金】：国家自然科学基金委员会医学科学部项目(No.61401258)
【分类号】：R614

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