股神经+坐骨神经联合股外侧皮神经阻滞麻醉对老年下肢骨折手术患者凝血功能、氧化应激和免疫功能的影响  

The effects of femoral nerve+sciatic nerve combined with lateral femoral cutaneous nerve block anesthesia on coagulation function,oxidative stress and immune function in elderly patients undergoing lower limb fracture surgery

作　　者：魏城 刘荣 WEI Cheng;LIU Rong(Department of Anesthesiology,Yingtan 184 Hospital,Yingtan,Jiangxi 335000,China)

机构地区：[1]鹰潭一八四医院麻醉科,江西鹰潭335000

出　　处：《检验医学与临床》2025年第7期950-956,共7页Laboratory Medicine and Clinic

基　　金：江西省鹰潭市科技计划项目(YKz20180033)。

摘　　要：目的探讨股神经+坐骨神经联合股外侧皮神经阻滞麻醉对老年下肢骨折手术患者凝血功能、氧化应激和免疫功能的影响。方法选取该院2023年3月至2024年5月收治的老年下肢骨折手术患者100例为观察对象,按照随机数字表法分为对照组、观察组,各50例。对照组采用全身麻醉,观察组采用股神经+坐骨神经联合股外侧皮神经阻滞麻醉。比较2组围术期各项相关指标、麻醉情况、血流动力学指标[平均动脉压(MAP)、心率(HR)]、凝血功能[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)]、氧化应激指标[超氧化物歧化酶(SOD)、活性氧(ROS)、丙二醛(MDA)]、免疫功能指标(CD4^(+)、CD8^(+)水平及CD4^(+)/CD8^(+)比值)、不良反应。结果2组手术时间、术中出血量、液体入量、输血率、术后首日的引流量比较,差异均有统计学意义(P>0.05)。单因素重复测量方差分析结果显示,观察组感觉阻滞起效时间、运动阻滞起效时间、清醒时间、术后肠鸣音恢复时间短于对照组,差异均无统计学意义(P<0.05)。观察组麻醉前、切皮时、剥离骨膜时、手术结束时的MAP、HR比较,差异均无统计学意义(P>0.05);对照组剥离骨膜时的MAP、HR高于麻醉前、切皮时、手术结束时,且手术结束时的MAP、HR高于麻醉前,差异均有统计学意义(P<0.05)。多变量方差分析结果显示,观察组剥离骨膜时、手术结束时的MAP、HR低于对照组,差异均有统计学意义(P<0.05)。与麻醉前比较,术后1 d 2组PT、APTT缩短,观察组长于对照组,差异均有统计学意义(P<0.05);与麻醉前比较,术后1 d 2组FIB水平升高,观察组低于对照组,差异均有统计学意义(P<0.05)。与麻醉前比较,术后1 d 2组SOD、ROS、MDA水平升高,观察组低于对照组,差异均有统计学意义(P<0.05)。与麻醉前比较,术后1 d 2组CD4^(+)水平、CD4^(+)/CD8^(+)比值降低,CD8^(+)水平升高,观察组CD4^(+)水平、Objective To explore the effects of combined femoral nerve+sciatic nerve combined with lateral femoral cutaneous nerve block anesthesia on coagulation function,oxidative stress and immune function in elderly patients undergoing lower limb fracture surgery.Methods A total of 100 elderly patients who underwent lower limb fracture surgery in Yingtan 184 Hospital from March 2023 to May 2024 were selected as the observation subjects.Patients were randomly divided into control group and observation group,with 50 cases in each group,the control group received general anesthesia,the observation group was anesthetized with femoral nerve+sciatic nerve combined with lateral femoral cutaneous nerve block.The perioperative indexes,anesthesia status,hemodynamic indicators[mean arterial pressure(MAP),heart rate(HR)],coagulation function[prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB)],oxidative stress indicators[superoxide dismutase(SOD),reactive oxygen species(ROS),malondialdehyde(MDA)],immune function indicators(CD4^(+),CD8^(+),CD4^(+)/CD8^(+))and adverse reactions were compared.Results There was no statistically significant difference between the two groups in terms of surgical time,intraoperative blood loss,fluid intake,transfusion rate and drainage volume on the first day after surgery(P>0.05).The observation group had shorter sensory block time,motor block time,wakefulness time and postoperative bowel sound recovery time than those in the control group,the differences were statistically significant(P<0.05).The results of one-way repeated measures analysis of variance showed that there was no statistically significant difference in MAP and HR in the observation group before anesthesia,during skin incision,during periosteum peeling,and at the end of surgery(P>0.05).The MAP and HR of the control group during periosteal dissection were higher than those before anesthesia,during skin incision,and at the end of surgery,and the MAP and HR at the end of surgery were higher than those before anesth

关 键 词：股神经 股外侧皮神经 阻滞麻醉 下肢骨折 凝血功能 氧化应激 

分 类 号：R683[医药卫生—骨科学] R614[医药卫生—外科学]