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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
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| 篇名： | 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 |
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| 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（P＜0.05），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（P＜0.01）。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（P＜0.05）。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（P＜0.05）。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（P＜0.05）。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： | OBJECTIVE： To investigate the effects of dexmedetomidine on postoperative cognitive dysfunction （POCD） and perioperative T lymphocyte subsets in senile patients after total hip joint replacement. METHODS： 172 senile patients receiving hip joint replacement were randomly divided into observation group and control group， with 86 cases in each group. Both groups was given combined spinal anesthesia， and observation group was additionally given dexmedetomidine. Postoperative cognitive functional status and perioperative T lymphocyte subpopulation changes were observed in 2 groups. RESULTS： There was no significant difference of MMSE score 1 day before surgery， 3 and 7 days after surgery in observation group （P＜0.05）. MMSE score in control group significantly decreased 3 days after surgery， there was statistical significance compared to before surgery （P＜0.05） and recovered to normal level 7 days after surgery. The incidence of POCD in observation group was 9.3％， which was significantly lower than （22.1％） in control group， with statistical significance （P＜0.01）. In the two groups， serum IL-1β， IL-6 and TNF-α levels were significantly higher than that before anesthesia 5 min after induction， once after the withdrawal of maintaining drug； this was more significant in control group， with statistical significance （P＜0.05）. Serum inflammatory factors in observation group recovered to preoperative level 1 h after surgery， while serum inflammatory factors in control group were still significantly higher than that before anesthesia， with statistical significance （P＜0.05）. 5 min after anesthesia induction， CD3， CD4， CD4/CD8 were significantly higher than that before anesthesia； this was more significant in control group， with statistical significance （P＜0.05）. CONCLUSIONS： Dexmedetomidine plays a role of auxiliary sedation in senile patients during combined spinal anesthesia total hip joint replacement， has a certain effect on reducing POCD incidence. This is related to its effect of reducing inflammation and maintaining the stability of T lymphocytes. |
| 期刊： | 2016年第27卷第2期 |
| 作者： | 金鑫，金超，周艳瑾 |
| AUTHORS： | JIN Xin，JIN Chao，ZHOU Yanjin |
| 关键字： | 右美托咪定；老年患者；髋关节置换术；术后认知功能障碍；T淋巴细胞亚群 |
| KEYWORDS： | Dexmedetomidine； Elderly patients； Total hip joint replacement； Postoperative cognitive dysfunction； T lymphocyte subsets |
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