右美托咪定对老年患者髋关节置换围术期炎症反应和肾脏功能的影响

发布时间：2018-03-27 09:39

本文选题：右美托咪定　切入点：髋关节置换　出处：《中国现代医学杂志》2017年10期

【摘要】：目的观察右美托咪定用于老年患者髋关节置换术后的治疗效果、炎症因子及肾功能的影响,为后续手术用药的选择提供依据。方法选取2013年1月-2015年12月在该院行髋关节置换术的老年患者100例,按随机数字表法分为两组,每组各50例。实验组患者给予静脉滴注右美托咪定4μg/ml,10 min后以0.2μg/(kg·h)+咪达唑仑+丙泊酚维持;对照组给予静脉滴注0.9%氯化钠溶液+咪达唑仑+丙泊酚。比较麻醉前、术中及术后的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_2)、血清中的肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、肌酐(Cr)、血尿素氮(BUN)浓度、血清和尿液肾损伤分子-1(KIM-1)及中性粒细胞明胶酶相关脂质运载蛋白(NGAL)。记录并观察患者的丙泊酚用量和清醒时间、术后不良反应的发生率及术前、术后的认知能力。结果术前、术中两组患者的MAP、HR、SpO_2、TNF-α、CRP及IL-18差异无统计学意义(P0.05);术后实验组的MAP和HR水平比较差异无统计学意义(P0.05)。术中、术后实验组的炎症因子表达均低于对照组且随时间的增加而增加,差异有统计学意义(P0.05)。术前两组患者Cr、BUN、血清、MMSE分数、尿液中NGAL和KIM-1表达水平差异无统计学意义(P0.05);术中、术后实验组的Cr、BUN、血清、尿液中NGAL和KIM-1表达均低于对照组且随时间的增加而增加,差异有统计学意义(P0.05)。实验组丙泊酚的用量、清醒时间及不良反应的发生率低于对照组而MMSE分数相反,差异有统计学意义(P0.05)。结论右美托咪定用于老年人髋关节置换术具有良好的治疗效果,可抑制炎症因子的表达,不良反应发生率较低,而且对肾脏有良好的保护作用。
[Abstract]:Objective to observe the effects of dexmetomidine on hip replacement, inflammatory factors and renal function in elderly patients. Methods from January 2013 to December 2015, 100 elderly patients undergoing hip arthroplasty in our hospital were divided into two groups. There were 50 patients in each group. The patients in the experimental group were treated with dexmetomidine 4 渭 g / ml for 10 min and maintained with 0.2 渭 g/(kg / h midazolam propofol, while the control group was given intravenous drip of 0.9% sodium chloride solution of midazolam propofol. Before anesthesia, the patients in the control group were treated with midazolam propofol. Heart rate during and after operation, mean arterial pressure (map), blood oxygen saturation (SPO), serum tumor necrosis factor- 伪 (TNF- 伪 TNF- 伪) C-reactive protein (CRPN), creatinine (Cr), blood urea nitrogen (bun). Serum and urine renal injury molecule (-1 KIM-1) and neutrophil gelatinase-associated lipid carrier protein (NGALL). The dosage and waking time of propofol, the incidence of postoperative adverse reactions and the cognitive ability before and after operation were recorded and observed. There was no significant difference in the levels of MAP and HR between the two groups during operation (P 0.05). The expression of inflammatory factors in the experimental group was lower than that in the control group and increased with the increase of time. There was no significant difference between the two groups of patients before operation, the score of serum MMSE and the expression level of NGAL and KIM-1 in urine, there was no significant difference between the two groups before operation (P 0.05), while in the experimental group, there was no significant difference between the two groups before and after operation (P 0.05). The expression of NGAL and KIM-1 in urine was lower than that in control group and increased with the increase of time, the difference was statistically significant (P 0.05). The dosage of propofol, the waking time and the incidence of adverse reactions in the experimental group were lower than those in the control group, but the MMSE score was opposite. Conclusion dexmetomidine has a good therapeutic effect on the elderly hip arthroplasty, can inhibit the expression of inflammatory factors, the incidence of adverse reactions is low, and has a good protective effect on the kidney.
【作者单位】：西南医科大学附属医院麻醉科;
【分类号】：R614

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