【摘要】 目的探讨不同麻醉方法对老年骨科下肢手术患者C反应蛋白(CRP)及补体变化的影响,以期找到更适合老年下肢骨科手术的麻醉方法,减少术后并发症,以促进老年患者的康复。方法 90例老年择期行下肢骨科手术的患者,ASAⅠ～Ⅱ级,随机均分为单纯硬膜外麻醉组(1组,n=30)、静脉复合麻醉组(2组,n=30)及静脉复合麻醉+硬膜外麻醉组(3组,n=30)。分别在麻醉前(T1)、术毕(T2)、术后24 h(T3)及术后72 h(T4)分别抽取患者外周静脉血,测定CRP及补体C3、C4水平。结果与同组内麻醉前(T1)时段比较,3组患者CRP在术后24 h(T3)及术后72 h(T4)均有不同程度增高,差异有统计学意义(P<0.05),但与组间同时段比较,3组增高幅度较小,并在术后72 h能恢复至麻醉前水平。与同组内麻醉前(T1)时段比较,1、2组C3在术毕(T2)有所降低,差异有统计学意义(P<0.05),但在术后24 h能升至麻醉前水平,而Ⅲ组C3在组内各时段无明显变化;与其他两组比较,Ⅲ组C3在术后72 h(T4)增高,差异有统计学意义(P<0.05)。与同组内麻醉前(T1)时段比较,2组C4在T2、T3时段明显降低(P<0.05),而其他两组在各时段变化比较差异无统计学意义(P>0.05);与其他两组比较,2组C4在术后72 h(T4)降低,差异有统计学意义(P<0.05)。结论单纯硬膜外阻滞或单纯全麻不足以减轻老年患者下肢部手术过程中的应激反应,对免疫功能有不同程度抑制作用,硬膜外加全麻则可明显减轻这些患者的应激反应,并对免疫功能无明显影响。更多还原

【Abstract】 Objective To study the effect of three different anesthesia methods on the C reactive protein and complement in elderly patients undergoing lower limb surgery of orthopedics.Methods Thirty patients were randomly divided into three groups: epidural anesthesia a lone(Ⅰgroup),balanced anesthesia(Ⅱgroup)and epidural anesthesia combined with balanced anesthesia(Ⅲ group).C reactive protein(CRP)and complement in blood serum were detected at before induction(T1),the end of operative procedure(T2),24 hour after operation(T3)and 72 hour after operation(T4).Results Compared to T1,C reactive protein(CRP) in three groups were significantly higher at T3,T4 respectively(P<0.05),but Compared to other group at the same time,the extent of CRP in Ⅲ group were just lightly increased at T3(P<0.05)and recovered to normal range in 72 hour after operation.Compared to T1,C3 inⅠandⅡ group were significantly decreased at T2 respectively(P<0.05),but recovered to normal range in 24 hour after operation,while C3 in Ⅲ group were no significantly changed at different times;Compared to the other group,C3 in Ⅲ group were significantly higher than those in ⅠandⅡ group respectively(P<0.05).Compared to T1,C4 in Ⅱ group were significantly decreased at T2,T3 respectively(P<0.05),while those inⅠand Ⅲ group were no changed at different times;Compared to the other group,C4 in Ⅱgroup were significantly lower than that those in Ⅰand Ⅲ group respectively(P<0.05).Conclusion Either epidural anesthesia or balanced anesthesia alone cannot reduce the stress response during operation in elderly patients undergoing lower limb surgery of orthopedics.Epidural anesthesia combined with general anesthesia may significantly reduce the stress response to surgery and does not significantly influence on immunological function.更多还原