右美托咪定对老年骨科手术病人炎症反应及氧化应激指标的影响

Influence of dexmedetomidine on the inflammatory reaction and oxidative-stress parameters in elderly patients treated with orthopedic surgery

目的:比较不同浓度右美托咪定对老年骨科手术病人早期认知功能影响及炎症指标变化的影响。方法:选择老年骨科全麻手术病人90例,年龄60~85岁,ASAⅠ~Ⅲ级,排除严重的肝肾疾病及活动性炎症。随机分成0.5μg/kg右美托咪定组(D1组)、1.0μg/kg右美托咪定组(D2组)及对照组(C组),各30例;采用简易智能状态检查量表评价病人术前和术后认知功能,比较3组病人麻醉前5 min、手术开始后30 min、手术结束时、术后2 h、术后1 d及术后3 d的炎症指标[血清白细胞介素-1β(IL-1β)、IL-6、肿瘤坏死因子-α(TNF-α)和超敏C反应蛋白(hs-CRP)]水平和氧化应激指标[血清超氧阴离子(O2-)、羟自由基(OH)、丙二醛(MDA)、和超氧化物歧化酶(SOD)]水平。结果:D1组、D2组和C组术前各炎症指标水平差异均无统计学意义(P>0.05);与术前比较,C组各时点各指标至术后3 d水平呈逐渐上升趋势;D1组血清IL-1β术毕和术后2 h升高但低于C组,IL-6、TNF-α、hs-CRP自手术开始30 min至术后3 d水平逐渐升高且均低于C组;D2组各时点血清IL-1β水平无明显变化,IL-6、TNF-α、hs-CRP分别于术毕和术后2 h、开始30 min至术后2 h、开始30 min至术后3 d较术前增高。D1组、D2组和C组术前各氧化应激指标水平差异无统计学意义;与术前比较,D1组和D2组血清O2-、MDA自术毕至术后3 d水平逐渐升高且D2组<D1组<C组,SOD水平则逐渐减低但D2组>D1组>C组,血清OH自手术开始30 min至术后3 d水平逐渐升高但均低于C组。结论:右美托咪定通过抑制机体炎症反应和氧化应激反应可降低老年骨科手术病人术后早期认知功能障碍的发生。

Objective:To investigate the effects of different concentrations of dexmedetomidine(DEX)on early cognitive function and inflammatory parameters in elderly patients treated with orthopedic surgery.Methods:Ninety elderly patients treated with general anesthesia operation,aged60to85years,ASAⅠ~Ⅲand without severe liver and kidney disease and active inflammation,were divided into the0.5μg/kg DEX group(group D1),1.0μg/kg DEX group(group D2)and control group(group C)(30cases each group).The preoperative and postoperative cognitive function in three groups were evaluated using Mini Mental State Examination(MMSE).The inflammatory parameters[including serum interleukin-1β(IL-1β),serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and high-sensitivity C-reactive protein(hs-CRP)]and oxidative stress parameters[including serum super-oxide anion(O2-),hydroxy radical(OH),malondialdehyde(MDA)and super-oxide dismutase(SOD)]between three groups before5min of anesthesia(T0),after30min of begining operation(T1),at the end of operation(T2),postoperative2h(T3),postoperative1d(T4)and postoperative3d(T5)were compared.Results:The differences of inflammatory parameters between three groups before operation were not statistically significant(P>0.05).Compared with before operation,all parameters in group C gradually increased after3d of operation.The serum levels of IL-1βin group D1at T2and T3increased,but which was lower than that group C.The serum levels of IL-6,TNF-αand hs-CRP in group D1gradually increased from T1to T5,but which was lower than that in group C.There was not significant change of the levels of IL-1βin group D2at each time-point,and the levels of IL-6,TNF-αand hs-CRP in group D2at T2,T3,from T1to T3and from T1to T5gradually increased with compared before operation.The differences of the oxidative stress parameters between three groups with before operation were not statistically significant.Compared with before operation,the levels of O2-and MDA in group D1and D2gradually increased from T2to T5,and which in group D2was lower than that in group D1and C.Compared with before operation,the level of SOD gradually decreased,and the level of SOD in group D2was higher than that in group D1and C.Compared with before operation,the level of OH in group D1and D2gradually increased,which in group D2and D1from T1to T5were lower that in group C.Conclusions:DEX can reduce the early cognitive dyfunction in elderly patients treated with orthopedic surgery by inhibiting oxidative stress and inflammation reaction.