摘要
目的探讨连续股神经阻滞复合全身麻醉对老年患者膝关节置换术后免疫功能的影响。方法选择60例行全膝关节置换术的患者,采用随机数字法分为对照组(CG组,n=30)和观察组(PG组,n=30)。CG组患者给予单纯全身麻醉,PG组患者用0.2%罗哌卡因行连续股神经阻滞后复合全身麻醉。分别在麻醉前(T_0)、术毕(T_1)、手术后1 d(T_2)、术后3 d(T_3)抽取患者静脉血3 ml,采用流式细胞术测定T_淋巴亚群CD3^+、CD4^+、CD8^+和NK细胞的水平,计算CD4^+/CD8^+。结果 CG组患者在T_1和T_2时的心率(P)和血压(Bp)较T_0时均下降(P<0.05或P<0.001),PG组患者在T_1、T_2和T_3时的P和Bp较T_0时均下降(P<0.05或P<0.001);PG组患者在T_3时的P和Bp低于CG组(P<0.01或P<0.001)。CG组患者T_1和T_2时CD3^+、CD4^+、NK细胞和CD4^+/CD8^+较T_0时降低,CD4^+在T_3时升高(P<0.05或P<0.001),PG组患者CD3^+、CD4^+和NK细胞在T_1、T_2、T_3时较T_0时均下降,CD4^+/CD8^+在T_2、T_3时较T_0时下降(P<0.05,P<0.01或P<0.001);PG组患者CD3^+、CD4^+和NK细胞在T_2和T_3时低于CG组,CD4^+/CD8^+在T_3时低于CG组(P<0.05,P<0.01或P<0.001)。结论连续股神经阻滞复合全身麻醉组能减轻全膝关节置换术后炎症反应,对患者免疫系统的影响较小,值得临床推广。
Objective To investigate the effect of continuous femoral nerve block combined with general anesthesia on immune function of knee arthroplasty. Methods 60 patients with knee arthroplasty were selected and randomly divided into control group（ group G,n = 30） and observation group（ group PG,n = 30）. Group G were general anesthesia alone,group PG were treated with 0. 2% of ropivacaine continuous femoral nerve block combined with general anesthesia. 3ml blood was extracted before anesthesia（ T0）,surgery（ T1）,1 day after surgery（ T2）,3 days after surgery（ T3）,respectively. T lymphocyte subsets CD3＋,CD4＋and NK cells was measured by flow cytometry and the levels of CD4＋/ CD8＋was calculated. Results Compared with T0,the P and BP at T1 and T2in group G were decreased（ P〈0.05 or P〈0.001） and the P and BP at T1,T2 and T3in group PG were decreased（ P〈0.05 or P〈0.001）; the P and BP at T_3 in group PG were decreased than that in group G（ 〈P0.01 or P〈0.001）. CD3＋,CD4＋,NK cells and CD4＋/ CD8＋at T1 and T2in group G were decreased and CD4＋was increased at T3 than that at T0（ P〈0.05 or P〈0.001）,CD3＋、CD4＋and NK cells at T1,T2 and T3 in group PG were decreased and CD4＋/ CD8＋was decreased at T2 and T3than that at T0（ P〈0.05,P〈0.01 or P〈0.001）.CD3＋、CD4＋and NK cells at T2 and T3in group PG were decreased than that in group G（ P〈0.05,P〈0.01 or P〈0. 001）. Conclusions Continuous femoral nerve block combined with general anesthesia can reduce the inflammation of knee replacement and have less effect on the immune function.
出处
《齐齐哈尔医学院学报》
2016年第26期3264-3266,共3页
Journal of Qiqihar Medical University
