右美托咪定辅助全身麻醉在老年全髋置换术中的应用

Application of Dexmedetomidine Combined with General Anesthesia on Postoperative Total Hip Replacement in Elderly Patients

目的 探讨右美托咪定辅助全身麻醉对老年全髋置换术(THA)患者术后效果影响.方法 选取70例择期行THA治疗的患者,根据随机数字表法分为观察组与对照组,各35例.对照组采用常规麻醉,观察组加用盐酸右美托咪定(剂量1μg/kg),再以0.2~0.6μg/(kg·h)维持到手术结束.采用视觉模拟评分法(VAS)比较两组患者术后进入麻醉复苏室(术后)、术后6,12,24h疼痛程度;采用简易精神状态量表(MMSE)比较两组患者术前、术后3d及7d的认知功能;采用酶联反应吸附检测法(ELISA)比较两组患者术前、术后30min、12h、24h血清中CRP,IL-6,TNF-α水平;采用流式细胞学检查(FCM)比较两组患者术前、术后30min、12h、24h血清中CD3^+,CD4^+,CD8^+,CD4^+/CD8^+含量.结果 在术后6,12h时间点VAS评分比较中,观察组患者评分均低于对照组(P<0.05);在术后3d,观察组患者MMSE量表评分高于对照组(P<0.05);在术后30min、术后12h、术后24h的检测时间点中,观察组患者血清中的CRP,IL-6,TNF-α含量水平均明显低于对照组(P<0.05);在术后30min、术后12h、术后24h的检测时间点中,观察组患者血清中的CD3^+,CD4^+,CD4^+/CD8^+含量水平均明显高于对照组(P<0.05),而CD8^+含量水平低于对照组(P<0.05).结论 右美托咪定辅助常规全身麻醉可缓解THA术后疼痛,改善术后认知功能,提高患者免疫水平.

Objective To investigate the effect of dexmedetomidine combined with general anesthesia on postoperative total hip arthroplasty (THA) in elderly patients.Method70 cases of THA were selected.According to the random number table method,they were divided into the observation group and the control group ,35 cases in each group.The control group received routine anesthesia,while the observation group was given dexmedetomidine hydrochloride (dose1μg/kg),and then maintained at 0.2 to 0.6μg/(kg·h) until the end of operation.Visual analogue scale (VAS) was used to compare the pain level of2 groups after the anesthesia recovery room (postoperative),postoperative 6 h,12 h and24 h.The cognitive functions of2 groups were compared before and after3days and 7 days after operation by using the mini Mental State Scale (MMSE).Enzyme linked immunosorbent assay (ELISA ) was used to compare serum levels of CRP,IL-6 and TNF-alpha in2 groups before and after 30 min,12 h and24 h.Flow cytometry (FCM) was used to compare the serum CD3^+,CD4^+,CD8^+ and CD4^+/CD8^+ levels in2 groups before and after 30 min,12 h and24 h. Results VAS score comparison at 6 h and12 h points after the operation,the scores of the patients in the observation group were lower than those in the control group ( P <0.05),and the MMSE scale in the observation group was higher than that of the control group ( P <0.05) after the operation ( P <0.05).In the postoperation 30 min, postoperative12 h,and the detection time of24 h after the operation,the patients in the observation group had CRP,IL-6 ,and TNF-α in the sera of the group.The level of the content was significantly lower than that of the control group ( P <0.05);The levels of CD3^+,CD4^+ and CD4^+/CD8^+ in the serum of the patients in the observation group were significantly higher than those in the control group ( P <0.05) at 30 min after operation,12 h after operation and24 h after operation.The level of CD8^+ was lower than that of the control group( P <0.05).Conclusion Dexmedetomidine assisted general general anesthesia can relieve the pain after THA,improve the postoperative cognitive function,reduce the severe translation and improve the immunity level.