B超引导腰丛联合坐骨神经阻滞对老年髋关节手术患者免疫功能、应激状况及术后镇痛的影响

Effects of B ultrasound-guided lumbar plexus combined with sciatic nerve block on immune function,stress response,and postoperative analgesia in older adult patients undergoing hip surgery

目的探讨B超引导腰丛联合坐骨神经阻滞对老年髋关节手术患者免疫功能、应激状况及术后镇痛的影响,为临床诊治提供理论依据。方法选取2018年8月至2019年8月温州市中西医结合医院收治的300例行老年髋关节手术患者进行研究,采用随机数字表法分为观察组和对照组各150例。对照组患者实施全身麻醉,观察组患者实施B超引导腰丛联合坐骨神经阻滞麻醉。记录两组患者在气管插管即刻(Tl)、手术2 h(T2)、术毕(T3)和术后24 h(T4)的血流动力学和皮质醇水平变化,观察两组患者术后3个月的免疫功能指标,并比较两组患者各时段的疼痛评分。结果观察组患者在T1~T4时刻的收缩压、舒张压、心率水平[(122.14±8.68)mmHg、(117.41±8.72)mmHg、(109.62±8.43)mmHg、(127.82±7.83)mmHg、(83.47±6.32)mmHg、(72.34±7.02)mmHg、(67.13±6.72)mmHg、(74.15±7.12)mmHg、(71.94±7.64)次/min、(71.84±7.11)次/min、(63.52±6.16)次/min、(73.43±7.29)次/min]均明显低于对照组[(131.22±8.69)mmHg、(125.81±8.76)mmHg、(115.11±8.44)mmHg、(133.26±7.85)mmHg、(89.28±6.12)mmHg、(77.64±7.13)mmHg、(75.51±8.02)mmHg、(81.13±7.14)mmHg、(79.24±7.65)次/min、(75.27±7.13)次/min、(70.54±6.22)次/min、(80.11±7.32)次/min],差异均有统计学意义(t=9.05、8.32、5.63、6.00,t=8.08、6.48、9.80、8.47,t=8.26、4.17、9.82、7.91,均P<0.001)。观察组患者在T2~T4时刻的皮质醇水平[(332.28±15.64)ng/L、(334.67±15.77)ng/L、(331.40±15.68)ng/L]均明显低于对照组[(344.75±15.63)ng/L、(346.02±15.76)ng/L、(345.83±15.66)ng/L],差异均有统计学意义(t=6.90、6.23、7.97,均P<0.001)。观察组术后3个月的辅助性T细胞(CD_(4)^(+)T)、细胞毒性T细胞(CD_(8)^(+)T)、辅助性T细胞/细胞毒性T细胞的比值(CD_(4)^(+)/CD_(8)^(+))水平[(31.39±6.72)%、(25.73±6.24)%、1.31±0.38]均明显低于对照组[(38.61±6.73)%、(32.79±6.25)%、1.52±0.39],差异均有统计学意义(t=9.29、9.79、4.72,均P<0.001)。观察组在术后12 h~48 h的疼痛评分[(1.59±0.54)分、(1.47±0.33)分、(1.55±0.41)分]均明显低于对照组[(2.72±0.55)分、(2.29±0.36)分、(2.39±0.43)分],差异均有统计学意义(t=17.95、20.56、17.31,均P<0.001)。结论B超引导腰丛联合坐骨神经阻滞能有效稳定老年髋关节手术患者的血流动力学,减少患者应激反应的发生,促进免疫功能的恢复,缓解患者的疼痛。

Objective To investigate the effects of B ultrasound-guided lumbar plexus combined with sciatic nerve block on immune function,stress response,and postoperative analgesia in older adult patients undergoing hip surgery,providing theoretical evidence for clinical diagnosis and treatment.Methods We included 300 older adult patients undergoing hip surgery who received treatment in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from August 2018 to August 2019 in this study.We randomly allocated them into the observation and control groups(n=150/group).The control group was subject to general anesthesia and the observation group was subject to B ultrasound-guided lumbar plexus combined with sciatic nerve block.Hemodynamic changes and plasma cortisol levels were recorded in each group immediately after endotracheal intubation(T1),at 2 hours of surgery(T2),at the end of surgery(T3),and 24 hours after surgery(T4).Each patient's immune function was assessed 3 months after surgery.The Visual Analog Scale score at each time point was compared between the two groups.Results The systolic blood pressure,diastolic blood pressure,and heart rate in the observation group at T1-T4 were(122.14±8.68)mmHg,(117.41±8.72)mmHg,(109.62±8.43)mmHg,(127.82±7.83)mmHg,(83.47±6.32)mmHg,(72.34±7.02)mmHg,(67.13±6.72)mmHg,(74.15±7.12)mmHg,(71.94±7.64)beats/minute,(71.84±7.11)beats/minute,(63.52±6.16)beats/minute,(73.43±7.29)beats/minute,respectively,which were significantly lower than those in the control group[(131.22±8.69)mmHg,(125.81±8.76)mmHg,(115.11±8.44)mmHg,(133.26±7.85)mmHg,(89.28±6.12)mmHg,(77.64±7.13)mmHg,(75.51±8.02)mmHg,(81.13±7.14)mmHg,(79.24±7.65)beats/minute,(75.27±7.13)beats/minute,(70.54±6.22)beats/minute,(80.11±7.32)beats/minute,t=9.05,8.32,5.63,6.00,t=8.08,6.48,9.80,8.47,t=8.26,4.17,9.82,7.91,all P<0.001].Plasma cortisol levels in the observation group at T2-T4 were(332.28±15.64)ng/L,(334.67±15.77)ng/L,(331.40±15.68)ng/L,respectively,which were significantly lower than those in the control group[(344.75±15.63)ng/L,(346.02±15.76)ng/L,(345.83±15.66)ng/L,t=6.90,6.23,7.97,all P<0.001].At 3 months after surgery,the proportion of CD_(4)^(+)helper T cells,the proportion of CD8+cytotoxic T cells,and the ratio of proportion of CD_(4)^(+)Helper T cells to the proportion of cytotoxic CD8+T cells in the observation group were(31.39±6.72)%,(25.73±6.24)%,1.31±0.38,respectively,which were significantly lower than those in the control group[(38.61±6.73)%,(32.79±6.25)%,1.52±0.39,t=9.29,9.79,4.72,all P<0.001].At 12-48 hours after surgery,The Visual Analog Scale scores in the observation group were(1.59±0.54)points,(1.47±0.33)points,(1.55±0.41)points,respectively,which were significantly lower than those in the control group[(2.72±0.55)points,(2.29±0.36)points,(2.39±0.43)points,t=17.95,20.56,17.31,all P<0.001].Conclusion B ultrasound-guided lumbar plexus combined with sciatic nerve block can effectively stabilize the hemodynamics in older adult patients undergoing hip surgery,reduce the occurrence of the stress response,promote the recovery of immune function,and alleviate pain.