七氟烷静吸复合麻醉对老年髋关节骨折手术患者应激反应、免疫功能及术后镇静的影响

Effects of Sevoflurane Intravenous-inhalation Combined Anesthesia on Stress Response, Immune Function and Postoperative Sedation in Elderly Patients Undergoing Hip Fracture Surgery

目的探讨七氟烷静吸复合麻醉对老年髋关节骨折手术患者应激反应、免疫功能及术后镇静的影响。方法选取2014年12月—2017年12月我院收治的106例老年髋关节骨折患者,按照不同麻醉方法分为观察组56例和对照组50例。所有患者麻醉诱导相同,对照组予丙泊酚麻醉,观察组在对照组基础上联合七氟烷吸入麻醉。记录并比较两组麻醉诱导开始前即刻(T0)、术后12 h(T1)、术后24 h(T2)和术后48 h(T3)时血浆肾上腺素(AD)、去甲肾上腺素(NE)、皮质醇和CD 3+、CD 4+/CD 8+比值、自然杀伤细胞百分比水平,以及两组T1、T2时Ramsay镇静评分(ramsay sedation score,RSS)。结果术后各时点两组AD和NE均较T0时降低,而皮质醇均较T0时升高,且观察组术后各时点AD、NE和皮质醇水平均较对照组低,差异均有统计学意义(P<0.05或P<0.01)。观察组T1和T2时CD 3+和CD 4+/CD 8+比值较T0时下降(P<0.05),T3时又升至T0时水平(P>0.05);T1时两组自然杀伤细胞较T0时升高(P<0.05),T2、T3时又降至T0时水平(P>0.05)。观察组术后各时点CD 3+、CD 4+/CD 8+比值均显著高于对照组,自然杀伤细胞仅T1时高于对照组,差异均有统计学意义(P<0.05或P<0.01)。术后随着时间的延长,两组RSS评分逐渐降低,且T1和T2时观察组RSS评分显著低于对照组,差异均有统计学意义(P<0.05或P<0.01)。结论七氟烷静吸复合麻醉可一定程度减轻老年髋关节骨折患者术后应激反应,保护机体免疫功能,且具有更为显著的镇静作用。

Objective To investigate the effects of sevoflurane intravenous-inhalation combined anesthesia on stress response,immune function and postoperative sedation in patients undergoing hip fracture surgery.Methods A total of 106 elderly patients with hip fracture treated in our hospital between December 2014 and December 2017 were selected.According to different anesthesia,they were divided into observation group(n=56)and control group(n=50).With all patients under the same condition for anesthesia induction,the control group was given propofol anesthesia,while observation group was supplemented with sevoflurane inhalation anesthesia.The plasma adrenaline(AD),norepinephrine(NE),plasma cortisol and CD 3+,CD 4+/CD 8+ratios,natural killer cell percentage,and Ramsay sedation score(RSS)at T1 and T2 were recorded and compared between the two groups.Results At different time points,AD and NE were decreased,and cortisol was increased,compared with that at T0.The levels of AD,NE and cortisol in the observation group were lower than those in the control group at different time points(P<0.05 or P<0.01).The CD 3+level and CD 4+/CD 8+ratio at T1 and T2 in the observation group were decreased compared with those at T0(P<0.05),and the levels at T3 was increased to the levels at T0(P>0.05).At T1,the percentage of natural killer cells of the two groups were higher than those at T0(P<0.05),and at T2 and T3 decreased to the levels at T0(P>0.05).The postoperative CD 3+level and CD 4+/CD 8+ratio in the observation group were significantly higher than those in the control group at different time points.The percentage of natural killer cells was higher than that of the control group only at T1(P<0.05 or P<0.01).The RSS scores in both groups were gradually decreased with time,and the RSS scores of the observation group at T1 and T2 were significantly lower than those of the control group(P<0.05 or P<0.01).Conclusion Sevoflurane intravenous-inhalation combined anesthesia can,to a certain extent,reduce the postoperative stress response,protect immune function in patients with hip fracture,and have a more significant sedative effect.