| 庄正陵,丁俊辉,柳洪周,等.早期康复锻炼联合硬膜外镇痛对髋关节置换术老年病人肢体功能和免疫功能的影响[J].安徽医药,2019,23(1):94-98. |
| 早期康复锻炼联合硬膜外镇痛对髋关节置换术老年病人肢体功能和免疫功能的影响 |
| Effects ofearly rehabilitation exercise combined with epidural analgesia on limb function recovery and immune function in elderly patients with hip replace |
| 投稿时间：2017-01-05 |
| DOI： |
| 中文关键词: 关节成形术,置换,髋 康复 镇痛,病人控制 CD4淋巴细胞计数 CD4-CD8比值 四肢 |
| 英文关键词: Arthroplasty,replacement,hip Rehabilitation Analgesia,patient-controlled CD4 lymphocyte count CD4-CD8 Ratio Extremities |
| 基金项目: |
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| 中文摘要: |
| 目的 探讨早期康复锻炼联合硬膜外自控镇痛对髋关节置换术后肢体功能和免疫功能的影响。方法 选择2014年1月至2015年12月襄阳市人民医院行髋关节置换术后老年病人(年龄>65岁)共82例,使用随机数字表法分为两组,早期康复锻炼联合硬膜外麻醉为观察组,静脉麻醉并要求卧床休息等常规干预为对照组,每组41例。在术前1 d、术后2 d和术后7 d留取血液标本,检测病人的免疫功能情况,同时比较两组病人Harris评分、并发症和自理能力BI指数。结果 术后7 d和术后1月,观察组病人的Harris积分(68.8±12.7)和(90.7±8.3)明显优于对照组(56.4±11.6)和(71.6±12.4)(t=4.617,8.195；P=0.008,0.001)。观察组病人的并发症发生总例数为4例(占9.7%),较对照组12例(占29.3%)明显降低(χ2=2.144,P=0.031)。术后7 d,观察组自理能力为(53.5±8.2),较对照组(44.3±7.4)明显升高(t=5.348,P=0.003)。术后2 d和术后7 d,观察组病人的CD4+淋巴细胞比例较对照组病人的CD4+淋巴细胞明显升高(P<0.05)；观察组病人的CD4+/CD8+的淋巴细胞比值,较对照组病人的CD4+/CD8+的淋巴细胞比值明显升高(P<0.05)。术后2 d和术后7 d两组病人在CD8+细胞比例的比较中,差异无统计学意义(P>0.05)。在术后2 d和术后7 d的比较中,观察组病人的IgG(117.6±20.1)及(125.9±20.7)和IgA(130.6±15.3)及(146.9±13.7)抗体水平明显高于对照组IgG(104.3±18.7)及(111.3±19.2)和IgA(100.5±14.8)及(105.2±14.8),差异有统计学意义(t=3.513,3.442和9.149,11.764；P=0.012,0.014和0.001,0.000)。结论 早期康复训练联合硬膜外镇痛能够促进术后病人肢体功能和免疫状态的恢复,降低炎症反应,减少感染等并发症的发生,促进病人的康复。 |
| 英文摘要: |
| Objective To evaluate effects of early rehabilitation exercise combined with patient-controlled epidural analgesia (PCEA) on limb function recovery and immune function in elderly patients with hip replace.Methods 82 elderly patients (>65 years old) undergoing hip replacement were selected and divided into two groups,with 41 patients in each group.Blood samples were collected at 1 day before operation,2 day after operation and 7 days after operation for immune function.BI and Harris scores were also compared.Results The Harris scores of case groups were (68.8±12.7) and (90.7±8.3),which were significantly higher than those in control groups (56.4±11.6) and (71.6±12.4) at 7 d and 1 month after operation (t=4.617,8.195；P=0.008,0.001).The total number of complications in the case group was 4 cases (9.7%),which was lower than that in the control group (12 cases,29.3%)(χ2=2.144,P=0.031).The self-care ability of the case group was (53.5±8.2),which was significantly higher than that of the control group (44.3±7.4) at 7 days after the operation (t=5.348,P=0.003).Significantly higher levels of CD4+ cells and CD4+/CD8+ were observed in case group than those in the control group at 2 day and 7 days after operation (P<0.05).There was no significant difference in the proportion of CD8+ cells between the two groups at 2 d and 7 d after operation (P>0.05).Significantly higher levels of IgG (117.6±20.1),(125.9±20.7) and IgA (130.6±15.3),(146.9±13.7) were observed in case group than those in the control group IgG (104.3±18.7),(111.3±19.2) and IgA (100.5±14.8).(105.2±14.8) at 2 day and 7 days after operation(t=3.513,3.442 and 9.149,11.764；P=0.012,0.014 and 0.001,0.000).Conclusion Early rehabilitation exercise combined with PCEA,performed in patients with hip replacement could promote the recovery of limb function recovery and immune status,reduce infection and other complications,and promote rehabilitation. |
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