右美托咪定对老年患者髋关节置换术后认知功能障碍及围术期T淋巴细胞亚群的影响

发布时间：2018-07-10 06:25

本文选题：右美托咪定 + 老年患者　；参考：《中国药房》2016年02期

【摘要】：目的:考察右美托咪定对老年患者髋关节置换术术后认知功能障碍(POCD)及围术期T淋巴细胞亚群的影响。方法:172例拟行髋关节置换术的老年患者按照随机数字表法分为观察组和对照组,各86例。两组患者均实施常规腰-硬联合阻滞麻醉,观察组在此基础上加用右美托咪定。观察两组患者术后认知功能及围术期T淋巴细胞亚群的变化。结果:观察组患者术前1 d、术后3 d、术后7 d的简易精神状态评价量表(MMSE)评分均未见明显变化;对照组患者术后3 d的MMSE评分显著降低,与术前1 d比较差异有统计学意义(P0.05),术后7 d恢复至术前水平。观察组患者的POCD发生率为9.3%,显著低于对照组的22.1%,差异有统计学意义(P0.01)。两组患者在诱导后5 min、维持药物停药即刻的血清白细胞介素(IL)-1β、IL-6、肿瘤坏死因子(TNF)-α水平均较麻醉前显著升高,尤以对照组升高得更为显著,差异有统计学意义(P0.05)。术后1 h,观察组患者的血清炎性因子恢复至术前水平,但对照组患者的血清炎性因子水平仍显著高于麻醉前,差异有统计学意义(P0.05)。麻醉诱导后5 min,两组患者的T淋巴细胞亚群CD3、CD4、CD4/CD8水平较麻醉前显著升高,但对照组升高得更显著,差异有统计学意义(P0.05)。结论:右美托咪定在老年患者腰-硬联合阻滞麻醉髋关节置换术中发挥了辅助镇静功效,对降低患者PCOD发生率具有一定作用。这与其降低炎性反应、维持T淋巴细胞数量稳定有关。
[Abstract]:Aim: to investigate the effects of dexmetomidine on cognitive dysfunction (POCD) and T lymphocyte subsets in elderly patients after hip arthroplasty. Methods 172 elderly patients undergoing hip replacement were randomly divided into two groups: observation group (n = 86) and control group (n = 86). Patients in both groups were given combined spinal-epidural block anesthesia, and the observation group was treated with dexmetomidine on this basis. The changes of postoperative cognitive function and T lymphocyte subsets were observed in both groups. Results: the MMSE scores of the patients in the observation group were not significantly changed 1 day before operation, 3 days after operation and 7 days after operation, but the MMSE scores of the patients in the control group were significantly lower than those in the control group on the 3rd day after operation. The difference was statistically significant compared with 1 day before operation (P0.05), and recovered to the preoperative level 7 days after operation. The incidence of POCD in the observation group was 9. 3%, which was significantly lower than that in the control group (22. 1%, P 0. 01). The levels of serum interleukin (IL)-1 尾 and tumor necrosis factor-伪 (TNF-伪) in the two groups were significantly higher than those before anesthesia 5 min after induction, especially in the control group (P0.05). At 1 hour after operation, the serum inflammatory factors of the patients in the observation group recovered to the preoperative level, but the levels of the serum inflammatory factors in the control group were still significantly higher than those before anesthesia, the difference was statistically significant (P0.05). 5 min after anesthesia induction, the T lymphocyte subsets CD3 T lymphocyte subsets CD4 / CD 4 / CD 8 increased significantly in the two groups compared with those before anesthesia, but in the control group, the difference was statistically significant (P0.05). Conclusion: dexmetomidine plays an auxiliary sedation effect in hip arthroplasty under combined spinal-epidural block and has certain effect on reducing the incidence of PCOD in elderly patients. This is related to the reduction of inflammatory response and the maintenance of stable T lymphocyte count.
【作者单位】：温岭市中医院麻醉科;
【分类号】：R614

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