[1]单勤亮,刘梅,苟永胜.神经刺激器定位下行腰丛复合坐骨神经阻滞对老年髋关节置换术患者免疫功能的影响[J].中华老年骨科与康复电子杂志,2021,(01):22-26.[doi:10.3877/cma.j.issn.2096-0263.2021.01.005]
　Shan Qinliang,Liu Mei,Gou Yongsheng.Effect of neurostimulator positioning of lumbar plexus combined with sciatic nerve block on immune function in elderly patients undergoing hip replacement[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2021,(01):22-26.[doi:10.3877/cma.j.issn.2096-0263.2021.01.005]
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神经刺激器定位下行腰丛复合坐骨神经阻滞对老年髋关节置换术患者免疫功能的影响()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2021年01期
页码:
22-26
栏目:
麻醉医学
出版日期:
2021-02-05

文章信息/Info

Title:
Effect of neurostimulator positioning of lumbar plexus combined with sciatic nerve block on immune function in elderly patients undergoing hip replacement
作者:
单勤亮1; 刘梅1; 苟永胜2
617063 攀钢集团总医院密地院区麻醉科1；610299 成都市双流区第一人民医院骨科2
Author(s):
Shan Qinliang1;  Liu Mei1;  Gou Yongsheng2
1Department of Anesthesiology, Midi District of General Hospital of Pangang Group, Panzhihua 617063, China; 2Department of Orthopaedics, Chengdu Shuangliu District First People’s Hospital, Chengdu 610299, China
关键词:
神经阻滞;  关节成形术; 置换; 髋;  免疫;  神经刺激器
Keywords:
Nerve block;  Arthroplasty;  replacement;  hip;  Immunity;  Nerve stimulator
DOI:
10.3877/cma.j.issn.2096-0263.2021.01.005
文献标志码:
A
摘要:
目的 探究神经刺激器定位下行腰丛复合坐骨神经阻滞对老年髋关节置换术患者术后免疫功能的影响。方法 前瞻性收集本院2016年2月至2018年10月收治的86例接受髋关节置换术治疗的老年患者为研究对象，依据随机数字表的方式分组，每组43例。其中，对照组进行硬膜外麻醉，观察组进行神经刺激器定位下腰丛复合坐骨神经阻滞麻醉。观察对比两组患者麻醉不同时间点T淋巴细胞亚群、炎症因子水平，感觉神经、运动神经阻滞时间，感染等不良反应发生情况。结果 观察组患者麻醉后T1与T2时间点T淋巴细胞亚群CD3+、CD4+、CD4+/CD8+水平均高于对照组（P＜0.05），同时炎症因子IL-6、TNF-α水平均低于对照组，差异有统计学意义（P＜0.05）；观察组患者感觉神经阻滞与运动神经阻滞起效时间快于对照组（P＜0.05）；维持时间明显长于对照组（P＜0.05）。并且观察组感染等不良反应发生率低于对照组，差异有统计学意义（P＜0.05）。结论 神经刺激器定位下腰丛复合坐骨神经阻滞麻醉对老年髋关节置换术患者的麻醉效果优于硬膜外麻醉，有利于维持患者T淋巴细胞亚群水平，减轻对免疫功能的影响，同时降低炎症反应及感染等不良反应发生，是老年髋关节置换术较为理想的麻醉方式。
Abstract:
Objective To explore the effect of neurostimulator positioning on the postoperative immune function of elderly patients undergoing hip replacement with lumbar plexus combined with sciatic nerve block. Methods Eighty-six elderly patients who underwent hip arthroplasty from February 2016 to October 2018 were enrolled in the study. They were grouped according to a random number table, with 43 patients in each group. Among them, the control group underwent epidural anesthesia, and the observation group underwent neurostimulator positioning under the lumbar plexus combined with sciatic nerve block anesthesia. The T lymphocyte subsets, inflammatory factor levels, sensory nerves, motor block time, infection and other adverse reactions occurred at different time points in the two groups. Results The levels of CD3+, CD4+, CD4+/CD8+ in T lymphocyte subsets in the observation group were significantly higher than the control group at the T1 and T2 time points (P<0.05). The levels of inflammatory factors IL-6 and TNF-α were significantly lower than the control group, which was statistically significant (P<0.05). In the observation group, the onset time of sensory nerve block and motor block was significantly faster than the control group (P<0.05); the maintenance time was significantly longer than the control group (P<0.05). And the incidence of adverse reactions such as observation group infection was significantly lower than the control group, which was statistically significant (P<0.05). Conclusions The neurostimulator positioning of the lumbar plexus combined with sciatic nerve block anesthesia is superior to epidural anesthesia in elderly patients undergoing hip replacement surgery, which is beneficial to maintain the level of T lymphocyte subsets, reduce the immune function, and reduce the inflammatory response. And the occurrence of adverse reactions such as infection is an ideal anesthesia method for elderly hip replacement.

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备注/Memo

备注/Memo:
基金项目：四川省卫生健康委员会科研课题（19PJ065）
更新日期/Last Update: 2021-03-26