右美托咪定联合地佐辛对腰麻下行老年髋部手术病人免疫功能和炎症反应的影响

Effects of dexmedetomidine combined with dezocine on immune function and inflamatory response in elders undergoing hip surgery under spinal anesthesia

目的探讨右美托咪定联合地佐辛对腰麻下行髋部手术老年病人术中镇静、术后疼痛、炎症因子和T淋巴细胞亚群的影响。方法收集60例ASAⅡ~Ⅲ级的拟行髋部手术的老年病人的资料,随机分为DD组和MS组,每组各30例。均采用腰麻,DD组采用右美托咪定和地佐辛辅助麻醉,MS组采用咪唑安定和舒芬太尼辅助麻醉。观察术后2、8、12、24 h的Ramsay镇静评分和VAS评分。术前、术后2、12、24 h采集外周静脉血标本,采用流式细胞仪检测T细胞亚群,采用酶联免疫法检测血IL-6、TNF-α的水平。结果两组各时间点的Ramsay镇静评分差异无统计学意义(P>0.05);DD组术后8、12 h的VAS评分均明显低于MS组(P<0.05);DD组IL-6、TNF-α水平术后2、12、24 h明显低于MS组(P<0.05);DD组术后2、12、24 h的CD3+细胞、CD4+细胞和CD4+/CD8+比值明显高于MS组(P<0.05)。结论对于老年髋部手术病人,采用右美托咪定联合地佐辛作为实施腰麻的辅助麻醉,可以取得良好的镇静效果,减轻术后疼痛、降低术后血IL-6、TNF-α水平和减轻术后血CD3+细胞、CD4+细胞比例和CD4+/CD8+比值的降低。

Objective To investigate the effects of dexmedetomidine combined with dezocine onperioperative sedation,postoperative pain,inflamatory factors and T lymphocyte subsets in elders undergoing hip surgery under spinal anesthesia.Methods 60 elders with ASA statusⅡ~Ⅲscheduled hip surgerywere divided into DD group and MS group,with 30 cases in each group.All patients were performed spinal anesthesia.Dexmedetomidine and dezocine were used in DD group while midazolam and sufentanilwere used in MS group for auxiliary anesthesia.Ramsay sedation scores and VAS scores were observed at 2,8,12,and 24 hours after operation.by flow cytometry and the blood levels of IL-6 and TNF-αwere detected by enzyme-linked immunoassay.Results There were no significant differences in Ramsay sedation scoresbetween the two groups at all time points(P>0.05);VAS scores at 8 h and 12 h after operation in DD group were significantly lower than those in MS group,(P<0.05);The blood levels of IL-6 and TNF-αat 2 h,12 h and 24 h after operation in DD group were significantly lower than those in MS group,(P<0.05);The levels of CD3+cells,CD4+cells and CD4+/CD8+ratio in DD group were significantly higher than those in MS group,(P<0.05).Conclusion Dexmetomidine combined with dezocine as auxiliary anesthesia for spinal anesthesia in elders undergoing hip surgery could achieve good sedative effects,relieve postoperative pain,reduce postoperative blood levels of IL-6,TNF-αand relive the decreases of postoperative blood percentage of CD3+cells,CD4+cell and the ratio of CD4+/CD8+.