中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2013年
3期
308-311
,共4页
程惠平%吴城%张中伟%陆惠根
程惠平%吳城%張中偉%陸惠根
정혜평%오성%장중위%륙혜근
舒芬太尼%布比卡因%镇痛,硬膜外%免疫
舒芬太尼%佈比卡因%鎮痛,硬膜外%免疫
서분태니%포비잡인%진통,경막외%면역
Sufentanil%Bupivacaine%Analgesia epidural%Immunity
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30 s内缓慢注射0.5％布比卡因3 ml(0.75％布比卡因2 ml+0.9％氯化钠1 ml),舒芬太尼组于30 s内缓慢注入0.25％布比卡因联合5μg舒芬太尼3m1(0.75％布比卡因1 ml+0.9％氯化钠1 ml+含5 μg舒芬太尼1 ml).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48 h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＜0.05).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＜0.05).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土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±0.10)％,与对照组相同时点指标比较差异有统计学意义(P＜0.05). 结论 鞘内注射5μg舒芬太尼联合低浓度布比卡因安全有效,降低局部麻醉药物浓度,加快老年患者术后麻醉平面恢复,加快术后早期免疫功能的康复.
目的 研究鞘內註射舒芬太尼聯閤佈比卡因對老年下肢骨科手術患者術後鎮痛的效果以及對圍術期細胞免疫功能的影響. 方法 60例符閤研究條件的老年下肢骨科手術患者被隨機分成對照組(30例)與舒芬太尼組(30例),對照組于30 s內緩慢註射0.5％佈比卡因3 ml(0.75％佈比卡因2 ml+0.9％氯化鈉1 ml),舒芬太尼組于30 s內緩慢註入0.25％佈比卡因聯閤5μg舒芬太尼3m1(0.75％佈比卡因1 ml+0.9％氯化鈉1 ml+含5 μg舒芬太尼1 ml).記錄手術切皮前患者痳醉感覺與運動阻滯平麵,記錄術後感覺運動阻滯平麵恢複時間,記錄術後1、6、12、24及48 h疼痛VAS評分與不良反應的情況.分彆鑑測相同時間術前、術後噹天、術後第5、10、15天的T淋巴細胞亞群以及活化CD4、活化CD8細胞、B細胞、NK細胞等免疫功能指標. 結果 對照組患者痳醉感覺阻滯平麵在胸椎7～8,運動阻滯平麵胸椎8～10;舒芬太尼組患者痳醉感覺阻滯平麵在胸椎9～10,運動阻滯平麵胸椎11～12;與對照組比較,舒芬太尼組感覺與運動阻滯恢複顯著縮短(P＜0.05).兩組術後不同時點VAS評分比較差異無統計學意義(P＜0.05).舒芬太尼組皮膚瘙癢6例,高于對照組(P＜0.05).對照組手術後第5天T細胞(CD3+)為(48.7±2.3)％；T輔助細胞為(33.4±1.8)％;T抑製細胞為(10.2±1.8)％；活化CD4細胞為(0.75±0.07)％；活化CD8細胞為(1.02±0.16)％；B細胞為(3.12±0.19)％；NK細胞為(2.53±0.14)％,與術前時間點相同免疫指標比較差異有統計學意義(P＜0.05).舒芬太尼組術後第5天T細胞為(54.5±2.4)％；T輔助細胞為(36.3±1.7)％；T抑製細胞為(15.1土1.6)％；活化CD4細胞為(1.32±0.11)％；活化CD8細胞為(1.25±0.14)％；B細胞為(4.96±0.25)％;NK細胞為(4.17±0.10)％,與對照組相同時點指標比較差異有統計學意義(P＜0.05). 結論 鞘內註射5μg舒芬太尼聯閤低濃度佈比卡因安全有效,降低跼部痳醉藥物濃度,加快老年患者術後痳醉平麵恢複,加快術後早期免疫功能的康複.
목적 연구초내주사서분태니연합포비잡인대노년하지골과수술환자술후진통적효과이급대위술기세포면역공능적영향. 방법 60례부합연구조건적노년하지골과수술환자피수궤분성대조조(30례)여서분태니조(30례),대조조우30 s내완만주사0.5％포비잡인3 ml(0.75％포비잡인2 ml+0.9％록화납1 ml),서분태니조우30 s내완만주입0.25％포비잡인연합5μg서분태니3m1(0.75％포비잡인1 ml+0.9％록화납1 ml+함5 μg서분태니1 ml).기록수술절피전환자마취감각여운동조체평면,기록술후감각운동조체평면회복시간,기록술후1、6、12、24급48 h동통VAS평분여불량반응적정황.분별감측상동시간술전、술후당천、술후제5、10、15천적T림파세포아군이급활화CD4、활화CD8세포、B세포、NK세포등면역공능지표. 결과 대조조환자마취감각조체평면재흉추7～8,운동조체평면흉추8～10;서분태니조환자마취감각조체평면재흉추9～10,운동조체평면흉추11～12;여대조조비교,서분태니조감각여운동조체회복현저축단(P＜0.05).량조술후불동시점VAS평분비교차이무통계학의의(P＜0.05).서분태니조피부소양6례,고우대조조(P＜0.05).대조조수술후제5천T세포(CD3+)위(48.7±2.3)％；T보조세포위(33.4±1.8)％;T억제세포위(10.2±1.8)％；활화CD4세포위(0.75±0.07)％；활화CD8세포위(1.02±0.16)％；B세포위(3.12±0.19)％；NK세포위(2.53±0.14)％,여술전시간점상동면역지표비교차이유통계학의의(P＜0.05).서분태니조술후제5천T세포위(54.5±2.4)％；T보조세포위(36.3±1.7)％；T억제세포위(15.1토1.6)％；활화CD4세포위(1.32±0.11)％；활화CD8세포위(1.25±0.14)％；B세포위(4.96±0.25)％;NK세포위(4.17±0.10)％,여대조조상동시점지표비교차이유통계학의의(P＜0.05). 결론 초내주사5μg서분태니연합저농도포비잡인안전유효,강저국부마취약물농도,가쾌노년환자술후마취평면회복,가쾌술후조기면역공능적강복.
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:bupivacaine 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:T0,the day before surgery; 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 T11～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+,CD4+/CD3+,CD4/HLADR,CD8/HLADR,B-cell,NK-cell between time points of T2[(48.7±2.3)％,(33.4±1.8)％,(10.2±1.8)％,(0.75±0.07)％,(1.02±0.16)％,(3.12 ±0.19) ％,(2.53±0.14)％,respectively] and T0 in bupivacaine (P＜0.05).There were significant differences in the indexes for the immune condition including CD3+,CD4+/CD3+,CD4/HLADR,CD8/HLADR,B-cell,NK-cell at T2 between sufentanil group [(54.5 ± 2.4) ％,(36.3 ± 1.7) ％,(15.1±1.6)％,(1.32±0.11)％,(1.25±0.14)％,(4.96±0.25)％,(4.17±0.10)％,respectively] and bupivacaine (P＜0.05).Conclusions Intrathecal injection of 5 μg sufentanil combined with low concentration bupivacaine can be safely and effectively applied in elderly patients under lower extremity orthopaedic surgery,and can reduce local anesthetic concentration,shorten recovery time of anesthesia and accelerate the recovery of postoperative immunity function.
