蛛网膜下隙与硬脊膜外联合阻滞麻醉对老年髋关节置换术患者围手术期认知功能及免疫状态的影响

Effects of combined spinal-epidural anesthesia on perioperative cognitive function and immune status in elderly patients undergoing hip replacement

摘要:

目的 探讨蛛网膜下隙与硬脊膜外联合阻滞麻醉（以下简称腰麻-硬膜外联合阻滞）对老年髋关节置换术患者围手术期认知功能及免疫状态的影响。方法 选取2019年8月—2021年8月在淮北矿工总医院行髋关节置换术治疗的老年患者120例作为研究对象。按随机数字表法分为两组，A组60例接受全身麻醉，B组60例接受腰麻-硬膜外联合阻滞。比较两组患者的手术时间、术中出血量、镇痛药物剂量、镇痛持续时间、呼吸恢复时间及拔管时间，两组不同时间点的心率（HR）、平均动脉压（MAP）及血氧饱和度（SaO₂）、CD4⁺、CD8⁺、CD4⁺/CD8⁺及认知功能。结果 两组患者的手术时间、术中出血量、镇痛药物剂量比较，差异无统计学意义（P >0.05）；B组的镇痛持续时间、呼吸恢复时间及拔管时间均短于A组（P <0.05）。两组患者麻醉前、麻醉后30 min、术后30 min的HR、MAP、SaO₂比较，采用重复测量设计的方差分析，结果 ①不同时间点的HR、MAP有差异（P <0.05），SaO₂无差异（P >0.05）；②两组的HR、MAP有差异（P <0.05），SaO₂无差异（P >0.05）；③两组的HR、MAP变化趋势有差异（P <0.05），SaO₂变化趋势无差别（P >0.05）。两组患者麻醉前、手术结束时、术后24 h、术后48 h的CD4⁺、CD8⁺及CD4⁺/CD8⁺比较，采用重复测量设计的方差分析，结果 ①不同时间点的CD4⁺、CD8⁺及CD4⁺/CD8⁺有差异（P <0.05）；②两组的CD4⁺、CD8⁺及CD4⁺/CD8⁺有差异（P <0.05）；③两组的CD4⁺、CD8⁺及CD4⁺/CD8⁺变化趋势有差异（P <0.05）。B组术后24 h、48 h的MMSE评分均高于A组（P <0.05）。结论 腰麻-硬膜外联合阻滞应用于老年髋关节置换术中效果较好，可维持血流动力学稳定，对免疫细胞影响较小，利于术后认知功能的恢复。

Abstract:

Objective To investigate the effect of combined spinal-epidural anesthesia on perioperative cognitive function and immune status in elderly patients undergoing hip replacement.Methods Totally 120 elderly patients treated with hip replacement in Huaibei Mining General Hospital from August 2019 to August 2021 were grouped according to the randomized digital table method. In group A, 60 patients received general anesthesia, and 60 patients in group B received lumbar hard combined anesthesia. The effect of anesthesia was recorded in the two groups to compare the levels of hemodynamic indicators [heart rate (HR), mean arterial pressure (MAP) and blood oxygen saturation (SaO₂)], immune status indicators (CD4⁺, CD8⁺, and CD4⁺/CD8⁺), and cognitive function at different time points.Results There was no significant difference in operation time, intraoperative bleeding, and analgesic dose between the two groups (P > 0.05); The duration of analgesia, respiratory recovery time, and extubation time in group B were shorter than those in group A (P < 0.05). The HR, MAP, and SaO₂ of the two groups were compared before anesthesia, at 30 min after anesthesia, and 30 min after operation. The analysis of variance of repeated measurement design was used. Results showed: (1) There were differences in HR and map between different time points (P < 0.05); (2) There were differences in HR and MAP between the two groups (P < 0.05); (3) There were differences in HR and map between the two groups (P < 0.05). The levels of CD4⁺, CD8⁺, and CD4⁺/CD8⁺ before anesthesia, at the end of operation, 24 hours after operation, and 48 hours after operation were compared between the two groups. Results showed: (1) There were significant differences in CD4⁺, CD8⁺, and CD4⁺/CD8⁺ at different time points (P < 0.05); (2) There were significant differences in CD4⁺, CD8⁺, and CD4⁺/CD8⁺ in the two groups (P < 0.05); (3) There were significant differences in CD4⁺, CD8⁺, and CD4⁺/CD8⁺ in the two groups (P < 0.05). The MMSE score of Group B was higher than that of group A at 24 h and 48 h postoperatively (P < 0.05).Conclusion The application of lumbar hard combined anesthesia in elderly hip replacement can maintain stable hemodynamic index, have less effect on immune cells, and facilitate the recovery of postoperative cognitive function.