右美托咪定复合腰硬联合麻醉对全髋关节置换患者认知功能及血清炎性因子的影响

Effect of dexmedetomidine combined with spinal epidural anesthesia on cognitive function and serum inflammatory factors in patients with total hip arthroplasty

目的 探究并分析右美托咪定联合腰硬联合麻醉对全髋关节置换患者认知功能及血清炎性因子的影响。方法 选取2020年5月至2021年5月收治的髋关节置换术患者87例,按照随机数字表法将其分为观察组(n=43例)和对照组(n=44例)。对照组患者给予单纯腰硬联合麻醉,观察组患者在对照组基础上硬膜外给予右美托咪定,收集2组患者一般资料,观察并比较2组患者术中血流动力学,血清S-100β、肿瘤坏死因子(tumor necrosis factor, TNF-α)、白细胞介素-6(interleukin-6,IL-6)及简易智力状态检查量表(mini-mental state examination, MMSE)的影响。结果 2组术前,假体植入时,术毕即刻,术后6 h SpO2比较,差异无统计学意义(P>0.05),观察组术毕即刻HR、MAP较术前显著降低(P<0.05),观察组假体置入时、术毕即刻HR、MAP显著低于对照组(P<0.05),对照组假体置入时HR、MAP较术前显著升高(P<0.05),2组患者术前MMSE评分比较,差异无统计学意义(P>0.05),2组患者术后3 d MMSE评分较术前显著降低(P<0.05),观察组患者术后3 d MMSE评分显著高于对照组(P<0.05),术前观察组及对照组患者血清S-100β比较,差异无统计学意义(P>0.05),术后3 d观察组及对照组患者S-100β较术前显著升高(P<0.05),术后3 d观察组术后S-100β显著高于对照组(P<0.05),经重复方差分析,2组患者手术前后TNF-α、IL-6水平比较差异有统计学意义(P<0.05),术前2组TNF-α、IL-6含量比较差异无统计学意义(P>0.05),术后2组患者TNF-α、IL-6水平较术前显著升高(P<0.05),观察组术后3 d患者TNF-α、IL-6含量明显低于对照组(P<0.05)。结论 右美托咪定复合腰硬联合麻醉相对于单纯腰硬联合麻醉更能有效减少全髋关节置换患者术中血流动力学的波动,降低患者术后炎性因子水平,改善患者术后认知功能,值得临床推广。

Objective To explore and analyze the effects of dexmedetomidine combined with spinal epidural anesthesia on cognitive function and serum inflammatory factors in patients with total hip arthroplasty.Methods A total of 87 patients with hip arthroplasty treated in our hospital from May 2020 to may 2021 were randomly assigned to observation group(n=43 cases)and control group(n=44 cases).Spinal epidural anesthesia was performed in both groups,and dexmedetomidine was additionally administrated in observation group.Baseline characteristics,intraoperative hemodynamic indexes,expression levels of serum S-100β,tumor necrosis factorα(TNF-α)and interleukin-6(IL-6),and mini mental state examination(MMSE)scores were included as comparisons.Results There was no significant difference in oxygen saturation(SpO_(2))before operation,immediately after prosthesis implantation and 6 h after operation between groups(P>0.05).Heart rate(HR)and mean arterial pressure(MAP)immediately after operation in the observation group were significantly lower than those before operation(P<0.05),which at prosthesis implantation,and immediately after operation in observation group were significantly lower than those in control group(P<0.05).HR and MAP at prosthesis implantation in control group were significantly enhanced before operation(P<0.05).There was no significant difference in preoperative MMSE scores between the two groups(P>0.05).The MMSE scores at 3 days postoperatively were significantly lower than preoperative ones in both groups(P<0.05).The MMSE scores at 3 days postoperatively in the observation group were significantly higher than those in the control group(P<0.05).The serum S-100βlevel before operation was comparable between groups(P>0.05),which at 3 days postoperatively was significantly enhanced in both groups compared with before operation(P<0.05),and the elevation was more pronounced in observation group(P<0.05).After repeated analysis of variance,there were significant differences in the levels of TNF-αand IL-6 between the two groups before and after operation(P<0.05).There were no significant differences in the levels of TNF-αand IL-6 between the two groups before operation(P>0.05),which were significantly higher in both groups after operation,(P<0.05),and the increases were more pronounced in the observation group at 3 days postoperatively(P<0.05).Conclusion Dexmedetomidine combined spinal epidural anesthesia can effectively reduce the fluctuation of hemodynamics in patients with total hip arthroplasty,lower postoperative inflammatory factors and improve their postoperative cognitive function,which is worthy of clinical promotion.