不同剂量右美托咪定对老年脊柱手术患者免疫功能及认知功能的影响

发布时间：2018-04-28 15:37

本文选题：术后认知功能障碍 + 脊柱手术　；参考：《广东医学》2015年02期

【摘要】：目的比较不同浓度的右美托咪定对全麻下行脊柱手术老年患者免疫功能和术后认知功能的影响。方法 60例拟行脊柱手术的老年患者,年龄65~80岁,随机分成3组:由专人配置药液,每组20例:生理盐水(C组)、0.5μg/kg右美托咪定组(D1组)和1.0μg/kg右美托咪啶(D2组)。常规麻醉诱导和维持,手术结束送PACU。全程监测患者生命体征,于麻醉前10 min(T0)、手术结束时(T1)、手术后12 h(T2)、手术后48 h(T3)抽取外周血,用流式细胞仪检测T淋巴细胞(CD3+、CD4+、CD8+)、NK细胞(CD16+、CD56+)和炎症因子(TNF-α、IL-2)浓度,及用简易智能状态检测法(MMSE)评估患者术前1 d和术后3 d认知状态,评定术后认知功能障碍(POCD)的发生率。结果 3组患者围手术期生命体征平稳,D2组比D1、C组的心动过缓发生率增加。与T0时点相比,3组T淋巴细胞(CD3+、CD4+、CD8+)、NK细胞(CD16+、CD56+)在T1~T2时点明显降低,炎症因子(TNF-α、IL-1β)浓度增加(P0.05),T3时点逐渐恢复。与C组相比,D1和D2组在T1~T2时点T淋巴细胞、NK细胞明显增加,炎症因子浓度显著降低(P0.05);与D1组相比,D2组在T2时点T淋巴细胞(CD3+、CD4+、CD8+)NK细胞(CD16+、CD56+)及CD4/CD8明显增加(P0.05),TNF-α、IL-2浓度在T1时点显著降低(P0.05);通过MMSE评定,对照组7例(35%)发生POCD,D1组3例(15%)发生POCD,D2组1例(5%)发生POCD,差异有统计学意义(P0.05)。结论一定剂量的右美托咪定可改善老年脊柱手术患者术后免疫功能和降低术后认知功能障碍发生。
[Abstract]:Objective to compare the effects of dexmetidine at different concentrations on immune function and postoperative cognitive function in elderly patients undergoing spinal surgery under general anesthesia. Methods Sixty elderly patients, aged 65 to 80 years, who were planning to undergo spinal surgery, were randomly divided into 3 groups: group C (n = 20): saline group C (n = 20) and group D _ 2 (n = 20) treated with 0.5 渭 g/kg dexmetidine (n = 20) and group D _ 2 (n = 1.0 渭 g/kg). Routine anesthesia induction and maintenance, the end of the operation sent to PACU. The vital signs of the patients were monitored 10 minutes before anaesthesia, T _ 1 at the end of the operation, 12 hours after the operation and 48 hours after the operation. The peripheral blood was collected. The levels of CD16 / CD56) and the inflammatory factor TNF- 伪 IL-2 were detected by flow cytometry. MMSE was used to evaluate the cognitive status 1 day before and 3 days after operation, and to evaluate the incidence of post operative cognitive dysfunction (POCD). Results the incidence of bradycardia in D 2 group was higher than that in D 1 C group. Compared with the T 0 time point, the CD16 / CD56 of T lymphocyte CD3 / CD 4 / CD 8 / T cell in T 3 group decreased significantly at T1~T2 time point, and the concentration of inflammatory factor TNF- 伪 and IL-1 尾 increased gradually at the time point of P0.05 / T 3. Compared with group C, the NK cells of T lymphocytes in D 1 and D 2 groups increased significantly at the time of T1~T2. Compared with the D1 group, the concentration of inflammatory cytokines in T 2 group was significantly lower than that in the D1 group, and the levels of CD16 / CD56) and CD4/CD8 in T 2 group were significantly higher than those in the D1 group. The concentration of TNF- 伪 -IL-2 in T 1 group was significantly lower than that in the D 1 group, and was assessed by MMSE. In the control group (n = 7) POCDD D _ 1 (n = 3) occurred in group D _ 2 (n = 5). The difference was statistically significant (P 0.05). Conclusion certain dose of dexmetomidine can improve postoperative immune function and reduce postoperative cognitive dysfunction in elderly patients undergoing spinal surgery.
【作者单位】：南昌大学第一附属医院麻醉科;南昌大学第二附属医院麻醉科;
【分类号】：R614

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