摘要
目的比较神经阻滞复合喉罩全麻、腰硬联合麻醉与全身麻醉对行全髋关节置换术老年患者围术期炎症应激及免疫功能的影响。方法选择择期行单侧全髋关节置换术患者60例,男21例,女39例,年龄63~80岁,体质量指数17~35 kg/m^(2),ASAⅡ级或以上,随机分为3组:神经阻滞复合喉罩全麻组(N组)、腰硬联合麻醉组(E组)和全身麻醉组(G组),每组20例。N组给予腰骶丛神经阻滞复合喉罩全麻,E组给予腰硬联合麻醉,G组给予全身麻醉。术后各组采用自控镇痛(PCIA)。于术前24 h、术后1 h、术后24 h采集各组患者血液,采用酶联免疫吸附法(ELISA)检测血浆IL-10、皮质醇、CRP、IL-4、IFN-γ水平。记录术前24 h、术后12 h及术后24 h VAS疼痛评分。结果与G组比,N组术中瑞芬太尼用量减少(P<0.05)。各组间麻黄碱及阿托品使用差异无统计学意义(P>0.05)。与G组相比,N组及E组术后24 h血浆IL-4水平降低(P<0.05),IFN-γ/IL-4比值升高(P<0.05);术后1 h血浆皮质醇水平降低(P<0.05),术后24 h血浆IL-10、皮质醇、CRP水平降低(P<0.05)。与G组相比,N组术后12 h VAS评分减少并具有临床意义(P<0.05)。结论神经阻滞复合喉罩全麻以及腰硬联合麻醉相比于全身麻醉可以减少老年患者全髋关节置换术后免疫和炎症应激反应相关细胞因子的表达,其中神经阻滞复合喉罩全麻具有更优的镇痛效果。
Objective To compare the effects of nerve block combined with laryngeal mask anesthesia,combined spinal-epidural anesthesia,and general anesthesia on perioperative inflammatory stress and immune function in elderly patients undergoing total hip arthroplasty.Methods Totally 60 patients who underwent unilateral total hip arthroplasty,including 21 males and 39 females,aged 63~80 years,with a BMI of 17~35 kg/m^(2),ASAⅡor above,were randomly divided into nerve block combined with laryngeal mask anesthesia group(group N),combined spinal-epidural anesthesia group(group E),and general anesthesia group(group G),with 20 cases in each group.Group N was given lumbosacral plexus nerve block combined with laryngeal mask general anesthesia;group E combined spinal-epidural anesthesia,and group G general anesthesia.After the operation,each group adopted patient-controlled intravenous analgesia(PCIA).Blood samples of patients in each group were collected before surgery,1 hour and 24 hours after surgery.Enzyme-linked immunosorbent assay(ELISA)was used to detect plasma IL-10,cortisol,CRP,IL-4,and IFN-γlevel.VAS pain score was recorded 24 h before surgery,12 h and 24 h after surgery.Results Compared with that in group G,the dose of remifentanil in group N was reduced(P<0.05).There was no statistical difference in ephedrine and atropine use among the three groups(P>0.05).Compared with those in group G,the plasma IL-4 level of groups N and E were reduced after 24 hours of surgery(P<0.05),and the IFN-γ/IL-4 ratio increased(P<0.05);plasma cortisol level decreased 1 hour after surgery(P<0.05),and plasma IL-10,cortisol,and CRP level decreased 24 hours after surgery(P<0.05).Compared with that of group G,the VAS score of group N decreased 12 hours after surgery,showing clinical significance(P<0.05).Conclusion Compared with general anesthesia,nerve block combined with laryngeal mask anesthesia and spinal-epidural anesthesia can reduce the expression of immune and inflammatory stress-related cytokines after total hip replacement surgery in elderly patients,among which nerve block combined with laryngeal mask anesthesia has better analgesic effect.
作者
吴文棋
邓恋
马武华
蔡诚毅
WU Wenqi;DENG Lian;MA Wuhua;CAI Chengyi(Guangzhou University of Chinese Medicine,Guangzhou 510405,China;不详)
出处
《实用医学杂志》
CAS
北大核心
2023年第11期1409-1415,共7页
The Journal of Practical Medicine
基金
国家自然科学基金面上项目(编号:82074357)
贝朗麻醉科学研究基金(编号:BBDF-2019-009)。
关键词
腰骶丛神经阻滞
腰硬联合麻醉
免疫功能
应激反应
全髋关节置换术
lumbosacral plexus nerve block
combined spinal-epidural anesthesia
immune function
inflammatory stress
total hip arthroplasty
