右美托咪定对老年骨折患者围术期炎症反应及术后认知功能障碍的影响

Effect of Dexmedetomidine on Perioperative Inflammatory Response and Postoperative Cognitive Dysfunction in Elderly Patients with Fractures

目的 :探究右美托咪定对老年骨折患者围术期炎症反应及术后认知功能障碍的影响。方法 :选取2017年3月—2018年6月我院收治的老年骨折患者94例,根据麻醉方法不同分为观察组及对照组,各47例。两组患者均实施常规腰麻-硬膜外联合麻醉,观察组在此基础上加用右美托咪定[0.4μg/(kg·h)]。比较两组围术期炎症反应、苏醒情况,术后简易智力状态检查量表(MMSE)评分以及认知功能障碍(POCD)发生率。结果:T3、T4时两组肿瘤坏死因子(TNF)-α、超敏C反应蛋白(hs-CRP)、白细胞介素(IL)-6均较T1时升高,且观察组低于对照组,差异有统计学意义(P <0.05);T5时对照组TNF-α、IL-6、hs-CRP仍高于T1时,观察组则恢复至T1时点数值,两组比较差异有统计学意义(P <0.05);观察组拔管时间、睁眼时间、呼吸恢复时间及言语陈述时间均短于对照组,差异有统计学意义(P <0.05);术后1、3 d,两组MMSE评分均较术前降低,且观察组高于对照组,差异有统计学意义(P <0.01);观察组术后1、3 d的POCD发生率均低于对照组,差异有统计学意义(P <0.05)。结论:在老年骨折手术中,右美托咪定可有效抑制围术期炎症反应,对患者术后认知功能影响小。

Objective:To investigate the effect of dexmedetomidine on perioperative inflammatory response and postoperative cognitive dysfunction in elderly patients with fractures.Methods:94 elderly patients with fractures admitted to our hospital from March 2017 to June 2018 were selected and divided into an observation group and a control group according to different anesthesia methods,47 cases each.The patients in the two groups were given conventional spinal-epidural anesthesia,and the patients in the observation group were further treated with dexmedetomidine(0.4μg/(kg·h))The perioperative inflammatory response,recovery,postoperative mini-mental state examination(MMSE)scores and incidence of postoperative cognitive dysfunction(POCD)were compared between the two groups.Results:The levels of tumor necrosis factor(TNF)-α,hypersensitive C-reactive protein(hs-CRP)and interleukin(IL)-6 at T3 and T4 were higher than those at T1 in the two groups,and the levels in the observation group were lower than those in the control group,with statistically significant differences(P<0.05).The levels of TNF-α,IL-6 and hs-CRP at T5 were still higher than those at T1 in the control group,while the levels in the observation group recovered to the levels at T1,with statistically significant differences between the two groups(P<0.05).The extubation time,eyes-opening time,respiratory recovery time and verbal presentation time in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.05).The MMSE scores on the 1 st day and 3 rd day after operation were lower than those before operation in the two groups,and these indexes in the observation group were higher than those in the control group,with statistically significant differences(P<0.01).The incidence of POCD in the observation group was lower than that in the control group on the 1 st day and 3 rd day after operation,and the differences were statistically significant(P<0.05).Conclusion:Dexmedetomidine can effectively inhibit perioperative inflammatory response in the elderly patients undergoing fracture operation,and has little effect on postoperative cognitive function.