右美托咪定对老年患者髋关节置换术后血清S-100β、NSE、炎症因子及早期认知功能的影响

The infl uence of dexmedetomidine on S-100β protein,NSE, infl ammatory factors and early postoperative cognitive dysfunction in the elderly patients undergoing hip replacement surgery

目的观察右美托咪定对老年患者髋关节置换术后血清S^(-1)00β、神经元特异性烯醇化酶(NSE)、炎症因子及早期认知功能的影响。方法择期全身麻醉下髋关节置换术老年患者80例,年龄≥60岁,ASA分级Ⅱ或Ⅲ级。随机分为两组:右美托咪定组(D组)和生理盐水组(N组),各40例。两组患者均采取气管插管下静脉全身麻醉。D组患者于麻醉诱导前15min静脉泵入0.4μg/kg负荷量右美托咪定,15min内泵完,然后以0.2μg·kg^(-1)·h^(-1)的维持剂量持续至术毕。N组患者采用同样方式泵入等量生理盐水。于术前1d(T0)、术毕(T1)、术后1d(T2)、术后3d(T3)取患者静脉血标本,检测血清S-100β蛋白、NSE、肿瘤坏死因子(TNF-α)、白细胞介素6(IL-6)浓度。于T0、T2、T3时点采用简易智力状态检查法(MMSE)对患者认知功能进行评分,比较T2、T3时点术后认知功能障碍(POCD)的发生率。结果与T0比较,D组和N组在T1、T2血清S-100β、NSE浓度均升高,但D组患者T1、T2增幅均小于N组(P均<0.01)。与T0比较,D组和N组在T1、T2、T3血清TNF-α、IL-6浓度均升高,但D组患者T1、T2、T3增幅均小于N组(P均<0.01)。D组和N组在T2、T3时MMSE评分均下降,D组降幅小于N组(P均<0.01)。T2、T3时D组患者POCD发生率分别为10.0%、5.0%,N组POCD发生率分别17.5%、12.5%,两组POCD发生率有显著差异(P均<0.01)。结论右美托咪定可降低老年患者髋关节置换术后血清S-100β、NSE、TNF-α、IL-6增幅,改善术后早期MMSE评分,降低POCD发生率。

Objective To observe the effects of dexmedetomidine on S-100 p protein,neuron specific enolase(NSE),inflammatory factors and early postoperative cognitive dysfunction in the elderly patients undergoing hip replacement surgery.Methods A total of 80 ASA physical status II or IE patients,aged equal to or more than 60 years old,who were undergoing hip replacement,were randomly divided into two groups(40 cases in each group):dexmedetomidine group(group D)and saline group(group N).All the patients were given with general anesthesia.Dexmedetomidine was administered to the patients in group D with a loading dose of 0.4ug/kg at 15min before induction of anesthesia,followed by maintenance dose of 0.2ug.kg^-1.h^-1 while with the same dose of normal saline instead in group N.Venous blood samples were collected before operation(TO),rightly after operation(Tl),1 day(T2)and 3 days(T3)after operation.The level of S-100βprotein,NSE,tumor necrosis factor(TNF-a)and interleukin-6(IL-6)were tested.Cognitive function was assessed by Mini-Mental State Examination(MMSE)at TO,T2 and T3.The incidence of postoperative cognitive dysfunction(POCD)was compared at T2 and T3.Results Compared with TO,the concentrations of S-100βprotein and NSE at T1 and T2 all increased in group D and N,but the increase of T1 and T2 in group D was less than that in group N(P<0.01).Compared with TO,the concentrations of serum TNF-a,IL-6 at Tl,T2 and T3 increased in group D and N,but the increase in group D were less than that in group N(P<0.01).In group D and N,the score of MMSE decreased at T2 and T3,and the decrease in group D was less than that in group N(P<0.01).At T2 and T3,the incidence rates of POCD in group D were 10.0%and 5.0%,and in group N were 17.5%and 12.5%,there was a difference in the incidence of POGD in the two groups(P<0.01).Conclusion Dexmedetomidine can reduce the growing level of S-100βprotein,NSE,TNF-a and IL-6 in the elderly patients after hip replacement,improve the early MMSE score and reduce the incidence rate of POCD.