不同剂量右美托咪定麻醉维持对老年全髋关节置换术患者血流动力学、细胞免疫和认知功能的影响

Effects of Different Doses of Dexmedetomidine on Hemodynamics, Cellular Immunity and Cognitive Function in Elderly Patients Undergoing Total Hip Replacement

目的:探讨不同剂量右美托咪定麻醉维持对老年全髋关节置换术患者血流动力学、细胞免疫和认知功能的影响。方法:选取2017年3月~2019年8月期间我院收治的行全髋关节置换术的老年患者120例。采用随机数字表法分为对照组、低剂量组、高剂量组各40例。低剂量组和高剂量组麻醉维持分别持续泵入右美托咪定0.4μg/(kg·h)、0.8μg/(kg·h)维持麻醉,对照组给予0.9%氯化钠注射液持续泵入。比较三组患者围术期指标、血流动力学、细胞免疫、认知功能及不良反应。结果:高剂量组、低剂量组气管插管时(T2)、术毕5 min(T3)时间点心率(HR)、平均动脉压(MAP)均高于对照组,且低剂量组高于高剂量组(P<0.05)。高剂量组、低剂量组T2、T3时间点CD4^(+)、CD4^(+)/CD8^(+)均高于对照组,且高剂量组高于低剂量组(P<0.05);高剂量组、低剂量组T2、T3时间点CD8^(+)低于对照组,且高剂量组低于低剂量组(P<0.05)。术后1 d高剂量组、低剂量组简明精神状态量表(MMSE)评分较对照组高(P<0.05);低剂量组、高剂量组术后1 d的MMSE评分比较无差异(P>0.05)。低剂量组麻醉10 min后Ramsay镇静评分高于对照组、高剂量组(P<0.05);低剂量组术后苏醒时间、拔管时间较对照组、高剂量组短(P<0.05)。高剂量组的不良反应发生率高于对照组和低剂量组(P<0.05)。结论:老年全髋关节置换术患者术中采用右美托咪定麻醉维持,可维持血流动力学稳定,减轻免疫抑制及认知功能损害,安全性较好,其中以0.4μg/(kg·h)剂量的右美托咪定效果更佳。

Objective: To investigate the effects of different doses of dexmedetomidine on hemodynamics, cellular immunity and cognitive function in elderly patients undergoing total hip replacement. Methods: From March 2017 to August 2019, 120 elderly patients who underwent total hip replacement were selected. According to the random number table method, the patients were divided into control group, low dose group and high dose group with 40 cases each. Dexmedetomidine 0.4 μg/(kg·h)and 0.8 μg/(kg·h)were continuously pumped into the low dose group and high dose group respectively maintain anesthesia, 0.9% sodium chloride injection was continuously pumped into the control group. The perioperative indexes, hemodynamics, cellular immunity, cognitive function and adverse reactions were compared among the three groups. Results: The heart rate(HR) and mean arterial pressure(MAP) in the high dose group and the low dose group at the time of endotracheal intubation(T2), 5 min after operation(T3) time point were higher than those of the control group, and those in the low dose group were higher than those in the high dose group(P<0.05). CD4^(+)and CD4^(+)/CD8^(+)in high dose group and low dose group at T2 and T3 time points were higher than those in control group and those in the high dose group were higher than those in the low dose group(P<0.05). CD8^(+)in the high dose group and low dose group at T2 and T3 time points were lower than that in control group and that in the high dose group was lower than that in the low dose group(P<0.05). The Mini-mental state examination(MMSE) scores in the high dose group and low dose group at 1 d after operation were higher than those in the control group(P<0.05) and there was no significant difference between low dose group and high dose group at 1 d after operation(P>0.05). The sedation score of Ramsay in low dose group at 10 minutes after anesthesia were higher than that in control group and high dose group(P<0.05). The postoperative recovery time and extubation time in low dose group were shorter than those in control group and high dose group(P<0.05).The incidence of adverse reaction in the high dose group was higher than that in the control group and low dose group(P<0.05). Conclusion: In elderly patients undergoing total hip arthroplasty, the use of dexmedetomidine during the operation can maintain the hemodynamic stability, reduce the immunosuppression and cognitive impairment, with better safety, among which the dose of 0.4 μg/(kg·h)of dexmedetomidine is more effective.