右美托咪定联合轻比重腰椎麻醉用于高龄髋关节置换术的临床研究

Clinical study on dexmedetomidine combined with hypobaric lumbar anesthesia for elderly patients with hip replacement

目的:研究右美托咪定联合轻比重腰椎麻醉用于高龄髋关节置换术对疼痛介质分泌、炎症及应激反应激活的影响。方法:选择2015年3月~2017年6月期间在韩城市人民医院接受髋关节置换术且年龄>70岁的高龄患者,随机分为接受右美托咪定联合轻比重腰椎麻醉的实验组、接受单纯轻比重腰椎麻醉的对照组。手术前1天及手术后当天、手术后3天时,测定血清中疼痛介质、应激介质的含量及外周血中炎症分子的表达量。结果:与两组患者组内手术前比较,手术后当天、手术后3天时血清中CGRP、β-EP、SP、BK、TNF-α、ACTH、F-C、F-Ins、NE、MDA的含量以及外周血中NLRP3、Caspase-1、TLR4、NF-κB的mRNA表达量均显著升高且实验组患者手术后当天、手术后3天时血清中CGRP、β-EP、SP、BK、TNF-α、ACTH、F-C、F-Ins、NE、MDA的含量以及外周血中NLRP3、Caspase-1、TLR4、NF-κB的mRNA表达量均显著低于对照组。结论:右美托咪定联合轻比重腰椎麻醉用于高龄髋关节置换术能够减少疼痛介质分泌并减轻炎症及应激反应。

Objective： To study the effects of dexmedetomidine combined with hypobaric lumbar anesthesia on pain mediator secretion as well as inflammatory response and stress response activation in elderly patients with hip replacement. Methods： Elderly patients who were 〉70 years old and underwent hip replacement in Hancheng People＇s Hospital between March 2015 and June 2017 were chosen and randomly divided into the experimental group who accepted dexmedetomidine combined with hypobaric lumbar anesthesia and the control group who accepted hypobaric lumbar anesthesia alone. The levels of pain mediators and stress mediators in serum as well as the expression of inflammatory molecules in peripheral blood were measured before surgery, the same day after surgery and 3 days after surgery. Results： Compared with those of same group before surgery, CGRP, β-EP, SP, BK, TNF-α, ACTH, F-C, F-Ins, NE and MDA levels in serum as well as NLRP3, Caspase-1, TLR4 and NF-κB mRNA expression in peripheral blood of both groups significantly increased the same day after surgery and 3 days after surgery, and CGRP, β-EP, SP, BK, TNF-α, ACTH, F-C, F-Ins, NE and MDA levels in serum as well as NLRP3, Caspase-1, TLR4 and NF-κB mRNA expression in peripheral blood of experimental group the same day after surgery and 3 days after surgery were significantly lower than those of control group （ P 〈0.05）. Conclusion： Dexmedetomidine combined with hypobaric lumbar anesthesia for hip replacement in the elderly can reduce the secretion of pain mediators and relieve the inflammatory response and stress response.