本文選題：右美托咪定 + 老年患者��； 參考：《中國(guó)藥房》2016年02期

【摘要】：目的:考察右美托咪定對(duì)老年患者髖關(guān)節(jié)置換術(shù)術(shù)后認(rèn)知功能障礙(POCD)及圍術(shù)期T淋巴細(xì)胞亞群的影響。方法:172例擬行髖關(guān)節(jié)置換術(shù)的老年患者按照隨機(jī)數(shù)字表法分為觀察組和對(duì)照組,各86例。兩組患者均實(shí)施常規(guī)腰-硬聯(lián)合阻滯麻醉,觀察組在此基礎(chǔ)上加用右美托咪定。觀察兩組患者術(shù)后認(rèn)知功能及圍術(shù)期T淋巴細(xì)胞亞群的變化。結(jié)果:觀察組患者術(shù)前1 d、術(shù)后3 d、術(shù)后7 d的簡(jiǎn)易精神狀態(tài)評(píng)價(jià)量表(MMSE)評(píng)分均未見(jiàn)明顯變化;對(duì)照組患者術(shù)后3 d的MMSE評(píng)分顯著降低,與術(shù)前1 d比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后7 d恢復(fù)至術(shù)前水平。觀察組患者的POCD發(fā)生率為9.3%,顯著低于對(duì)照組的22.1%,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。兩組患者在誘導(dǎo)后5 min、維持藥物停藥即刻的血清白細(xì)胞介素(IL)-1β、IL-6、腫瘤壞死因子(TNF)-α水平均較麻醉前顯著升高,尤以對(duì)照組升高得更為顯著,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后1 h,觀察組患者的血清炎性因子恢復(fù)至術(shù)前水平,但對(duì)照組患者的血清炎性因子水平仍顯著高于麻醉前,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。麻醉誘導(dǎo)后5 min,兩組患者的T淋巴細(xì)胞亞群CD3、CD4、CD4/CD8水平較麻醉前顯著升高,但對(duì)照組升高得更顯著,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:右美托咪定在老年患者腰-硬聯(lián)合阻滯麻醉髖關(guān)節(jié)置換術(shù)中發(fā)揮了輔助鎮(zhèn)靜功效,對(duì)降低患者PCOD發(fā)生率具有一定作用。這與其降低炎性反應(yīng)、維持T淋巴細(xì)胞數(shù)量穩(wěn)定有關(guān)。
[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-偽 (TNF-偽) 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.
【作者單位】： 溫嶺市中醫(yī)院麻醉科;
【分類(lèi)號(hào)】：R614

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