舒芬太尼联合布比卡因对老年下肢骨科手术患者术后镇痛与免疫功能的影响

Effects of sufentanil combined with bupivacaine on postoperative analgesia and immune function in elderly patients undergoing lower extremity orthopedic surgery

目的分析舒芬太尼联合布比卡因对老年下肢骨科手术患者术后镇痛与免疫功能的影响。方法100例老年下肢骨科手术患者,基于平行、单盲、随机对照设计原则分为对照组和观察组,每组50例。术中实施椎管内麻醉,对照组应用布比卡因,观察组应用舒芬太尼联合布比卡因。比较两组术后视觉模拟评分法(VAS)评分及手术前后免疫学指标。结果观察组术后1 h VAS评分为(1.39±0.22)分,术后6 h VAS评分为(1.30±0.29)分,术后12 h VAS评分为(1.21±0.18)分,术后24 h VAS评分为(1.85±0.11)分,术后48 h VAS评分为(1.92±0.15)分;对照组术后1 h VAS评分为(1.48±0.21)分,术后6 h VAS评分为(1.98±0.12)分,术后12 h VAS评分为(2.15±0.36)分,术后24 h VAS评分为(2.20±0.39)分,术后48 h VAS评分为(2.24±0.32)分;观察组术后1、6、12、24、48 h的VAS评分均低于对照组,差异有统计学意义(P<0.05)。术后5、10、15 d,观察组CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)水平均高于对照组,差异有统计学意义(P<0.05)。结论舒芬太尼联合布比卡因应用于老年下肢骨科手术麻醉中,术后镇痛效果显著,对于细胞免疫学指标无明显影响,安全可靠,因此,值得推广及应用。

Objective To analyze the effects of sufentanil combined with bupivacaine on postoperative analgesia and immune function in elderly patients undergoing lower extremity orthopedic surgery.Methods A total of 100 cases of elderly patients with lower extremity orthopedic surgery as the research subjects.Based on the principle of parallel,single blind and randomized controlled design,they were divided into the control group and the observation group,with 50 cases in each group.Intraoperative spinal anesthesia was performed,the control group was treated with bupivacaine,and the observation group was treated with sufentanil and bupivacaine.The visual analogue scale(VAS)scores and immunological indexes before and after surgery were compared between the two groups.Results In the observation group,VAS scores were(1.39±0.22)points at 1 h postoperatively,(1.30±0.29)points at 6 h postoperatively,(1.21±0.18)points at 12 h postoperatively,(1.85±0.11)points at 24 h postoperatively,and(1.92±0.15)points at 48 h postoperatively;in the control group,VAS scores were(1.48±0.21)points at 1 h postoperatively,(1.98±0.12)points at 6 h postoperatively,(2.15±0.36)points at 12 h postoperatively,(2.20±0.39)points at 24 h postoperatively,and(2.24±0.32)points at 48 h postoperatively.VAS scores of the observation group at 1,6,12,24,and 48 h postoperatively were lower than those of the control group,and the difference was statistically significant(P<0.05).At 5,10 and 15 d postoperatively,the CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)levels in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).Conclusion The application of sufentanil combined with bupivacaine shows significant postoperative analgesic effect in elderly patients undergoing lower extremity orthopedic surgery,and it has no significant effect on cellular immunological indexes.This method is safe and reliable,and therefore worthy of promotion and application.