七氟醚联合右美托咪定对老年全膝关节置换术患者炎症应激反应和脑损伤标志物的影响

Effects of Sevoflurane Combined with Dexmedetomidine on Inflammatory Stress Response and Brain Injury Markers in Elderly Patients Undergoing Total Knee Arthroplasty

目的:观察右美托咪定、七氟醚复合麻醉对老年全膝关节置换术(TKA)患者脑损伤标志物、炎症应激反应的影响。方法:选取98例于2020年4月~2023年3月期间在我院接受治疗的老年TKA患者,采用随机数字表法将患者分为研究组(n=49,七氟醚联合右美托咪定麻醉)、对照组(n=49,七氟醚麻醉)。比较两组应激反应指标[皮质醇(Cor)、促肾上腺皮质激素(ACTH)]、脑损伤标志物[神经元特异性烯醇化酶(NSE)、S100β蛋白]、炎症因子[肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]水平,同时记录两组认知功能障碍(POCD)发生情况。结果:研究组术后1 d ACTH、Cor、TNF-α、CRP、S100β蛋白、NSE较对照组更低(P<0.05)。研究组的POCD发生率较对照组更低(P<0.05)。结论:老年TKA患者采用七氟醚联合右美托咪定麻醉,可减轻炎症应激反应和脑损伤,降低术后POCD发生风险。

Objective:To observe the effects of dexmedetomidine and sevoflurane combined anesthesia on brain injury markers and inflammatory stress response in elderly patients undergoing total knee arthroplasty(TKA).Methods:98 elderly TKA patients who were treated in our hospital from April 2020 to March 2023 were selected.Patients were divided into study group(n=49,sevoflurane combined with dexmedetomidine anesthesia)and control group(n=49,sevoflurane anesthesia)by random number table method.The levels of stress response[cortisol(Cor),adrenocorticotropic hormone(ACTH)],brain injury markers[neuron-specific enolase(NSE),S100βprotein],inflammatory factors[tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)]were compared between two groups,and the incidence of postoperative cognitive dysfunction(POCD)were recorded.Results:The levels of ACTH,Cor,TNF-α,CRP,S100βprotein and NSE in study group were lower than those in control group 1 d after operation(P<0.05).The incidence of POCD in study group was lower than that in control group(P<0.05).Conclusion:Sevoflurane combined with dexmedetomidine anesthesia in elderly TKA patients can reduce inflammatory stress response and brain injury,maintain hemodynamic stability,and reduce the risk of postoperative POCD.