右美托咪定辅助全身麻醉对全髋置换术患者认知功能、免疫功能及疼痛的影响

Effects of dexmedetomidine on generalized anesthesia on cognitive function、immune function and pain in patients undergoing total hip arthroplasty

目的探讨右美托咪定辅助全身麻醉对全髋置换术(THA)患者认知功能、免疫功能及疼痛的影响。方法选取山西省临汾市人民医院收治的80例全身麻醉下行THA患者,根据随机数字表法分为观察组与对照组,各40例。观察组给予盐酸右美托咪定处理。对照组无特殊处理。采用简易精神状态量表(MMSE)观察并比较两组患者认知功能,采用流式细胞学检查并比较两组术前(T0)、术后6 h(T6)、术后24 h(T24)、术后48 h(T48)及术后72 h(T72)CD3+、CD4+、CD8+、CD4+/CD8+水平,采用视觉模拟评分法(VAS)比较两组患者镇痛效果,观察并记录两组患者出现的并发症。结果在T6时,观察组MMSE评分高于对照组,差异有统计学意义(P<0.05);在T6、T24、T48时,观察组患者免疫功能各项指标含量均高于对照组,差异有统计学意义(P<0.05);在T2、T6、T10、T14、T18、T22时,观察组患者VAS评分低于对照组(P<0.05);观察组总并发症发生率明显低于对照组,差异有统计学意义(χ2=6.832,P=0.009)。结论右美托咪定辅助全身麻醉运用于老年全髋置换术患者效果显著,减轻患者术后免疫功能的抑制,降低患者术后认知功能障碍(POCD)发生风险。

Objective To investigate the effects of dexmedetomidine-assisted general anesthesia on cognitive function,immune function and pain in patients with total hip arthroplasty(THA).Methods Eighty patients with general anesthesia who underwent THA were enrolled in Linfen People's Hospital of Shanxi Province.According to the random number table method,they were divided into observation group and control group,40 cases each.The observation group was treated with dexmedetomidine hydrochloride.There was no special treatment in the control group.The cognitive function was observed and compared between the two groups using the Mini Mental State Scale(MMSE).Flow cytometry was performed and the preoperative(T0),6 h(T6),and 24 h(T24),surgery were performed.After 48 h(T48)and 72 h(T72),CD3+,CD4+,CD8+,CD4+/CD8+levels were compared.The visual analgesia(VAS)was used to compare the analgesic effects of the two groups.The complications of the two groups were observed and recorded.Results At T6,the MMSE score of the observation group was higher than that of the control group,the difference was statistically significant(P<0.05).At T6,T24,T48,the immune function index of the observation group was higher than that of the control group.Statistical significance(P<0.05);In T2,T6,T10,T14,T18,T22,the VAS score of the observation group was lower than that of the control group(P<0.05);the incidence of total complications in the observation group was significantly lower than that of the control group.The difference was statistically significant(χ2=6.832,P=0.009).Conclusion Dexmedetomidine is effective in the treatment of elderly patients with total hip arthroplasty.It can reduce the inhibition of postoperative immune function and reduce the risk of postoperative cognitive dysfunction(POCD).