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 immunity function inelderly patients under lower extremity orthopaedic surgery

作　　者：程惠平[1] 吴城[2] 张中伟[3] 陆惠根[3] 

机构地区：[1]浙江省嘉兴学院附属第一医院药剂科,314000 [2]浙江省嘉兴学院附属第二医院麻醉科 [3]浙江省嘉兴学院附属第二医院骨科

出　　处：《中华老年医学杂志》2013年第3期308-311,共4页Chinese Journal of Geriatrics

基　　金：嘉兴市科技计划项目（2009AY2042）

摘　　要：目的研究鞘内注射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的效果以及对围术期细胞免疫功能的影响。方法60例符合研究条件的老年下肢骨科手术患者被随机分成对照组（30例）与舒芬太尼组（30例），对照组于30S内缓慢注射0．5％布比卡因3ml（0．75％布比卡因2ml＋0．9％氯化钠1m1），舒芬太尼组于30S内缓慢注入0．25％布比卡因联合5／lg舒芬太尼3ml（0．75％布比卡因1ml＋0．9％氯化钠1ml＋含5／lg舒芬太尼1m1）。记录手术切皮前患者麻醉感觉与运动阻滞平面，记录术后感觉运动阻滞平面恢复时间，记录术后1、6、12、24及48h疼痛VAS评分与不良反应的情况。分别监测相同时间术前、术后当天、术后第5、10、15天的T淋巴细胞亚群以及活化CD4、活化CD8细胞、B细胞、NK细胞等免疫功能指标。结果对照组患者麻醉感觉阻滞平面在胸椎7～8，运动阻滞平面胸椎8～10；舒芬太尼组患者麻醉感觉阻滞平面在胸椎9～10，运动阻滞平面胸椎11～12；与对照组比较，舒芬太尼组感觉与运动阻滞恢复显著缩短（P〈0．05）。两组术后不同时点VAS评分比较差异无统计学意义（P〈0．05）。舒芬太尼组皮肤瘙痒6例，高于对照组（P〈O．05）。对照组手术后第5天T细胞（CD3＋）为（48．7±2．3）％；T辅助细胞为（33．4±1．8）％；T抑制细胞为（10．2±1．8）％；活化CD4细胞为（0．75±0．07）％；活化CD8细胞为（1．02±0．16）％；B细胞为（3．12±0．19）％；NK细胞为（2．53±0．14）％，与术前时间点相同免疫指标比较差异有统计学意义（P〈O．05）。舒芬太尼组术后第5天T细胞为（54．5±2．4）％；T辅助细胞为（36．3±1．7）％；T抑制细胞为（15．1±1．6）％；活化CD4细胞为（1．32±0．11）％；活化CD8细胞为（1．25±0．14）％；B细胞为（4．96±0．25）％；NK细胞为（4．17�Objective To investigate effects of intrathecal injection of sufentanil combined with bupivacaine on postoperative analgesia and immunity function in elderly patients under lower extremity orthopaedic surgery. Methods Totally 60 elderly patients with ASA I or Ⅲ under lower extremity orthopaedic surgery were randomly divided into two groups： hupivacaine and sufentanil group （each n =30）. 3 ml bupivacaine （2 ml 0.75% bupivacaine plus 1 ml 0.9% normal saline） were given in bupivacaine after successful spinal anesthesia and 3 ml sufentanil （1 ml 0.75% bupivacaine plus 1 ml 0.9% normal saline and 1 ml with 5 μg sufentanil） were used in sufentanil group respectively. The anesthetic feeling and block level before operation recovery time were recorded postoperation. Visual analogue scale （VAS） and adverse reaction were recorded at 1, 6, 12, 24 and 48 h after surgery. Cellular and humoral immunity function were recorded at the following time points： To, the day beforesurgery; T1, the day after surgery~ T2, the first 5 postoperative days; T3, the first 10 postoperative days; T4, the first 15 postoperative days. Results The sensory and motor block levels in sufentanil group were T9-T10 and Tll-T12 respectively, which were higher than in bupivacaine （T7-T8 and T8-T10）. The recovery time in sufentanil group was shorter than in the bupivacaine （P〈0.05）. There were no significant differences in VAS scale between the two groups at any postoperative time points （P〈0.05）. The incidence of skin pruritus was higher in sufentanil group （6 cases） than in bupivacaine （P〈0.05）. There were significant differences in the indexes for the immune condition including CD3＋, CD＋/CD3＋, CD4/HLADR, CDS/HLADR, B-cell, NK-cell between time points of Tz[（48.7±2.3）%, （33.4±1.8）%, （10.2±1.8）%, （0.75±0.07）%, （1.02=[=0.16）%, （3.12 ±0.19） %, （2. 534±0.14）%, respectively] and To in bupivacaine （P〈0.05）. There were significant differences in the indexes for the im

关 键 词：舒芬太尼 布比卡因 镇痛 硬膜外 免疫 

分 类 号：R614[医药卫生—麻醉学]