超声引导下腰丛复合坐骨神经阻滞对老年髋部骨折患者术后感染及免疫功能的影响  

Effects of ultrasound-guided lower plexus complex sciatic nerve block on postoperative infection and immune function in elderly patients with hip fracture

作　　者：余建英 王充[1] 邵亮[1] 吴平蕾 胡战兵 敖程斌 

机构地区：[1]台州市玉环县人民医院麻醉科,浙江台州317600

出　　处：《中华医院感染学杂志》2018年第2期229-232,共4页Chinese Journal of Nosocomiology

摘　　要：目的探讨老年髋骨骨折患者在接受不同麻醉方式后,对其术后感染以及免疫功能的影响。方法选取2014年3月-2017年1月于医院诊治的86例髋部骨折老年患者作为研究对象,按照不同的麻醉方式分为对照组42例和研究组44例;对照组患者采取常规腰丛复合坐骨神经阻滞麻醉,研究组患者采取超声引导下腰丛复合坐骨神经阻滞麻醉,对患者术后发生感染情况进行统计,同时监测术后6、24、72h患者的T淋巴细胞亚群(CD_3^+、CD_4^+、CD_8^+)比率变化和血清免疫球蛋白(IgG、IgM、IgE)水平变化。结果研究组患者术后有4例发生感染,感染率为9.09%,对照组术后有18例发生感染,感染率为42.86%,两组比较差异有统计学意义(P<0.05);研究组患者术后6、24、72h的T淋巴细胞亚群(CD_3^+、CD_4^+、CD_8^+)比率均优于对照组(P均<0.05);研究组患者术后6、24、72h的血清免疫球蛋白(IgG、IgM、IgE)水平明显高于对照组患者,两组比较差异均有统计学意义(P<0.05)。结论老年髋部骨折患者手术采取超声引导下腰丛复合坐骨神经阻滞麻醉方式,有利于降低患者术后感染率,能有效维持T淋巴细胞亚群浓度和血清免疫球蛋白含量水平,对老年患者的免疫功能影响较轻,是老年患者进行髋骨骨折手术比较理想的麻醉方式。OBJECTIVE To investigate the effects of different anesthesia methods on postoperative infection and immune function in elderly patients with hip fracture.METHODS A total of 86 elderly patients with hip fractures from Mar.2014 to Jan.2017 were chosen as the research object.The patients were divided into control group（42 cases）and observation group（44 cases）according to different anesthesia methods.Patients in control group were treated with conventional lumbar from composite sciatic nerve block anesthesia,and in observation group were taken with ultrasound-guided lower waist from the composite sciatic nerve block anesthesia.The patient′s postoperative infection and infection rate were taken for statistics.At the same time,the changes of T lymphocyte subsets（CD3^＋,CD4^＋,and CD8^＋）ratios and serum immunoglobulin（IgG,IgM,and IgE）levels at 6 h,24 hand 72 h after operation were monitored.RESULTS Totally 4 cases were infected in observation group,with the infection rate of 9.09%,and 18 cases were infected in control group,with the infection rate of 42.86%.There was significant difference between the two groups（P〈0.05）.The levels of T lymphocyte subsets of CD3^＋,CD4^＋and CD8^＋in observation group were better than those in control group at 6 h,24 hand 72 hafter operation（P〈0.05）.The levels of serum immunoglobulin of IgG,IgM and IgE in observation group were significantly higher than those in control group at 6 h,24 hand 72 hafter operation（P〈0.05）.CONCLUSION The ultrasound-guided composite sciatic nerve block anesthesia in elderly patients with hip fracture is helpful to reduce the postoperative infection of the patients,effectively maintain the concentrations of T lymphocyte subsets and the levels of serum immunoglobulin.It affects the immune function of elderly patients lightly,and it is the ideal anesthesia for elderly patients with hip fractures surgery.

关 键 词：老年患者 髋骨骨折 超声引导下 腰丛复合坐骨神经阻滞 术后感染 免疫功能 

分 类 号：R619.3[医药卫生—外科学]