术中亚低温疗法对老年急性肠梗阻疗效的影响

Effect of perioperative hypothermia therapy on elderly patients with acute intestinal obstruction

目的探讨术中亚低温疗法对老年急性肠梗阻患者围术期免疫功能及术后神经功能恢复的影响.方法选择宁波市北仑区中医院2010年1月至2015年12月治疗的老年急性肠梗阻患者80例为研究对象,采用随机数字表法分为两组,各40例.对照组术中实施常规对症支持处理,观察组在对照组基础上同时采用亚低温处理,观察两组CD4^+、CD8^+、CD4^+/CD8^+及免疫球蛋白变化,比较两组神经功能缺损程度评分(ESS)、日常生活能力评分(Barthel指数).结果干预后,观察组CD4^+、CD8^+、CD4^+/CD8^+分别为(35.1±2.0)%、(30.6±1.3)%、(1.9±0.3),均高于对照组的(26.0±0.9)%、(24.4±1.0)%、(1.6±0.2),两组均差异有统计学意义(t=26.242、23.908、5.262,均P<0.05);观察组IgM、IgG、IgA分别为(1.60±0.03)g/L、(9.50±0.12)g/L、(3.90±0.20)g/L,均高于对照组的(1.30±0.02)g/L、(8.80±0.10)g/L、(1.80±0.15)g/L,两组均差异有统计学意义(t=52.623、28.342、53.126,均P<0.05);观察组ESS、Barthel指数分别为(78.6±8.5)分、(77.3±6.6)分,对照组分别为(59.6±6.1)分、(62.6±5.4)分,两组均差异有统计学意义(t=11.486、10.902,均P<0.05).结论亚低温处理能有效减轻手术对老年急性肠梗阻患者免疫功能的影响,促进术后神经系统功能恢复,提高患者术后生活质量.

Objective To investigate the effects of perioperative hypothermia therapy on immune function and nerve function recovery in elderly patients with acute intestinal obstruction. Methods From January 2010 to December 2015,80 elderly patients with acute intestinal obstruction in the Traditional Chinese Medicine Hospital of Beilun District were selected and randomly divided into two groups,with 40 cases in each group. The control group was given conventional symptomatic treatment during operation,the observation group was given intraoperative hypothermia therapy on the basis of the control group. The CD4^+,CD8^+,CD4^+/ CD8^+ changes of immunoglobulin were observed in the two groups,the ESS(NIHSS) and Barthel index(daily life ability score) were compared between the two groups. Results After intervention,the CD4^+,CD8^+,CD4^+/ CD8^+ levels in the observation group were (35. 1 ±2. 0)%,(30. 6 ± 1. 3)% and (1. 9 ± 0. 3),respectively,which were higher than those in the control group[(26. 0 ± 0. 9)%,(24. 4 ± 1. 0)% and (1. 6 ± 0. 2)],the differences between the two groups were statistically significant(t = 26. 242,23. 908, 5. 262,all P <0. 05). The IgM,IgG,IgA levels in the observation group were (1. 60 ± 0. 03)g/ L,(9. 50 ± 0. 12)g/ L,(3. 90 ± 0. 20) g/ L,respectively,which were higher than those in the control group[(1. 30 ± 0. 02) g/ L,(8. 80 ± 0. 10)g/ L,(1. 80 ± 0. 15)g/ L],there were statistically significant differences between the two groups(t = 52. 623, 28. 342,53. 126,all P < 0. 05). The ESS,Barthel index in the observation group were (78. 6 ± 8. 5),(77. 3 ± 6. 6), respectively,which were higher than those in the control group[(59. 6 ± 6. 1),(62. 6 ± 5. 4)],there were statistically significant differences between two groups(t = 11. 486,10. 902,all P < 0. 05). Conclusion Hypothermia treatment can effectively reduce the effect of surgery on immune function in elderly patients with acute intestinal obstruction, promote the recovery of the nervous system,and improve the quality of life of the patients.