规范化康复训练联合硬膜外镇痛对老年髋关节置换术后患者肢体功能和免疫功能影响的临床研究(1)

http://www.100md.com 2020年10月25日 《中外医疗》 202030

     [摘要] 目的 研究分析老年髋关节置换术后患者肢体功能和免疫功能受规范化康复训练联合硬膜外镇痛的影响效果。方法 随机选取2018年2月—2019年8月在该院骨科行人工髋关节置换术后的患者72例为研究对象，并将单号病房患者作为对照组，双号病房患者作为实验组，其中对照组36例患者接受静脉麻醉与常规护理干预措施，实验组36例患者接受规范化康复训练联合硬膜外镇痛干预措施，对比两组患者Harris评分、并发症、自理能力以、细胞免疫功能及免疫球蛋白水平情况。结果 实验组并发症发生率2.77%(1/36)低于对照组22.22%(8/36)，组间对比差异有统计学意义(χ2=6.222，P=0.013);术后7 d，实验组自理功能评分(53.4±8.1)分明显好于对照组(44.2±7.3)分，组间对比差异有统计学意义(t=5.062，P<0.001);术后2 d相比，实验组Harris评分(54.8±8.3)分好于对照组(45.1±9.2)分，组间对比差异有统计学意义(t=4.697，P<0.001);术后7 d，实验组(68.6±12.5)分与对照组(56.2±12.2)分，两组之间对比差异有统计学意义(t=4.260，P<0.001)。术后2 d与7 d，两组患者CD4+以及CD8+比值组间对比差异有统计学意义(t=3.368、6.263、0.338、3.559，P<0.05)。術后2 d对比中，实验组患者IgG与IgA水平明显好于对照组，并且两组患者IgG与IgA水平均小于手术前水平，组间对比差异有统计学意义(t=4.785、8.598，P<0.05)。结论 规范化康复训练联合硬膜外镇痛能够改善老年髋关节置换术后患者免疫功能与肢体功能情况，降低患者并发症的发生，提升患者自理能力，具有较高的临床应用价值。

    [关键词] 规范化康复训练;硬膜外镇痛;髋关节置换术;肢体功能;免疫功能

    [中图分类号] R4 [文献标识码] A [文章编号] 1674-0742(2020)10(c)-0001-03

    [Abstract] Objective To study and analyze the effects of standardized rehabilitation training combined with epidural analgesia on the limb function and immune function of elderly patients after hip replacement. Methods A total of 72 patients who underwent artificial hip arthroplasty in the hospital from February 2018 to August 2019 were randomly selected as the research objects， and patients in the single ward were selected as the control group. Patients in the double ward were used as the experimental group. Among them， 36 patients in the control group received intravenous anesthesia and routine nursing interventions， and 36 patients in the experimental group received standardized rehabilitation training combined with epidural analgesia interventions. The Harris scores， complications， self-care ability，ceu immunefunction and immunoglobulin levels were compared between the two groups. Results The complication rate of the experimental group was 2.77% (1/36) lower than that of the control group 22.22%(8/36)， and the difference between the groups was statistically significant (χ2=6.222，P=0.013);7 d after the operation， the experimental group The score of self-care function (53.4±8.1)points was significantly better than that of the control group (44.2±7.3)points，and the difference between the groups was statistically significant (t=5.062， P<0.001); compared with 2 d after surgery， the Harris score of the experimental group(54.8±8.3)points was better than that of the control group (45.1±9.2)points， and the difference between the groups was statistically significant (t=4.697， P<0.001); 7 d after surgery， the Harris score of the experimental group(68.6±12.5)points was better than that of the control group (56.2±12.2)points， and the difference between the groups was statistically significant (t=4.260， P<0.001). At 2 and 7 d after operation， there was a statistically significant difference in the CD4+ and CD8+ ratios between the two groups(t=3.368， 6.263，P<0.05). In the last 2 d At 2 d After operation of comparison， the levels of IgG and IgA in the experimental group were significantly better than those in the control group， and the levels of IgG and IgA in the two groups were lower than the levels before surgery. The difference between the groups was statistically significant (t=4.785，8.598，P<0.05). Conclusion Standardized rehabilitation training combined with epidural analgesia can improve the immune function and limb function of elderly patients after hip replacement， reduce the incidence of complications， and improve the self-care ability of patients. It has high clinical application value.(徐银良 汪凯文 杨柳 陈德庆 陈灿 张祁)

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