右美托咪定用于老年全髋关节置换术的临床观察及对患者炎症因子的影响

Clinical observation and the influence of inflammatory cytokines of dexmedetomidine hydrochloride injection on the elderly patients with total hip replacement

目的探讨右美托咪定在老年全髋关节置换术中的镇静效果及对患者血清炎症因子的影响。方法将72例拟行全髋关节置换术患者按随机数字表法分为观察组和对照组,每组36例。所有患者均采用常规麻醉方法,观察组在此基础上增加右美托咪定镇静,分别于麻醉前（T0）、手术开始后30 min（T1）、术毕即刻（T2）、术后6 h（T3）、术后12 h（T4）、术后24 h（T5）测定2组患者Ramsay镇静评分、血清C-反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）,并比较2组苏醒期躁动、谵妄等并发症发生情况。结果观察组T1、T2和T3时间点Ramsay镇静评分显著高于对照组,差异均有统计学意义（P〈0.05）;观察组苏醒期躁动、谵妄发生率均显著低于对照组,差异有统计学意义（P〈0.05）;2组CRP、TNF-α、IL-6随着时间的延长呈显著上升的趋势,差异有统计学意义（P〈0.05）;观察组T1~T5时间点CRP、TNF-α、IL-6均显著低于对照组各时间点,差异有统计学意义（P〈0.05）。结论右美托咪定用于老年全髋关节置换术中可以增强镇静效果,降低炎症反应和并发症发生率。

Objective To explore the calm effect of dexmedetomidine hydrochloride injection in elderly patients with total hip replacement and the influence of inflammatory cytokines. Methods Seventy-two patients undergoing total hip replacement were divided into observation group and control group according to the stochastic indicator method,with 36 cases in each group. All patients were treated with general anesthesia method,on the basis of it,patients in observation group were administered dexmedetomidine hydrochloride injection. Ramsay sedation score was evalvated,and serum Creactive protein（ CRP）,tumor necrosis factor-α（ TNF-α）,interleukin 6（ IL-6） between two groups were detected and compared before anesthesia（ T0）,surgery after 30 min（ T1）,the end of the surgery（ T2）,6 h after surgery（ T3）,12 h after surgery（ T4）,24 h after surgery（ T5） respectively. The rate of emergence agitation, delirium and other complications between two groups were also compared. Results Ramsay sedation score in observation group was significantly higher than that in control group at T1,T2 and T3 point（ P 〈 0. 05）; The rate of emergence agitation and incidence of delirium in observation group were significantly lower than that of control group（ P 〈 0. 05）; the level of CRP,TNF-α and IL-6 in two groups rised at a time-dependent manner（ P 〈 0. 05）; CRP,TNF-α and IL-6 in observation group were significantly lower than those of control group at T1 to T5 time points（ P 〈 0. 05）. Conclusions Dexmedetomidine hydrochloride injection used in elderly with the total hip replacement can strengthen the sedative effect,reduce the inflammatory reaction and complications.