右美托咪定辅助麻醉对老年阿尔茨海默病髋关节置换术患者炎症因子及T淋巴细胞亚群的影响  

Effects of dexmedetomidine adjuvant anesthesia on inflammatory factors and T lymphocyte subsets in elderly patients with Alzheimer hip arthroplasty

作　　者：王小锐[1] 李阳阳[2] 万亮[1] 郭文艳[1] 李帛谦 张立涛[1] 董月颖 

机构地区：[1]河北省唐山市第二医院麻醉科 [2]河北省唐山市协和医院耳鼻喉科,河北唐山063000

出　　处：《海南医学院学报》2017年第7期925-927,931,共4页Journal of Hainan Medical University

基　　金：河北省科研课题项目(20150929)~~

摘　　要：目的:探讨右美托咪定辅助麻醉对老年阿尔茨海默病(AD)患者髋关节置换术(THR)炎症因子及T淋巴细胞亚群的影响。方法:选取我院收治的AD患者实施THR60例为研究对象,随机分为观察组和对照组各30例,两组患者严格术前准备,咪唑安定0.04mg/kg静脉注射,丙泊酚0.5~1.5mg/kg、顺阿曲库胺0.15mg/kg、芬太尼4μg/kg进行诱导麻醉,丙泊酚1.5~2.5mg/(kg·h)持续静脉泵注,瑞芬太尼0.04~0.4μg/(kg·min)维持麻醉深度,顺阿曲库铵间断松肌,观察组于麻醉诱导气管插管开始时15min右美托咪定1μg/kg静脉泵注,再以0.2~0.7μg/(kg·h)维持至手术结束。采集术前、术毕即刻、术后12h、术后24h外周静脉血,采用ELISA法测定C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平;采用流式细胞仪测定T淋巴细胞亚群(CD3^+、CD4^+、CD8^+)水平,计算CD4^+/CD8^+值;采用Ramsay镇静评分进行术前、术毕即刻、术后12h、术后24h评分。结果:观察组术毕即刻、术后12hRamsay镇静评分大于同期对照组(P<0.05);观察组术后即刻、术后12h、术后24h血清CRP、IL-6、TNF-α水平低于同期对照组(P<0.05);观察组术后即刻、术后12h、术后24h血清CD3^+、CD4^+、CD8^+水平及CD4^+/CD8^+值均高于同期对照组(P<0.05)。结论:右美托咪定对AD患者实施THR具有独特的镇痛、镇静作用,可有效抑制炎症因子的释放,从而改善机体免疫功能。Objective：To explore the effect of dexmedetomidine assisted anesthesia on the inflammatory cytokines and T lymphocyte subsets in elderly patients with Alzheimer disease（AD）underwent total hip replacement（THR）.Methods：A total of 60 patients with AD who were admitted in our hospital from October 2014,to October 2016 for THR were included in the study and randomized into the observation group and the control group with 30 cases in each group.Strict preoperative preparation was performed.The patients in the two groups were given intravenous injection of midazolam（0.04mg/kg）,propofol（0.5~1.5）mg/kg,cisatracurium（0.15mg/kg）,and fentanyl（4μg/kg）for anesthesia induction,continuously venous pumping of propofol（1.5~2.5）mg/kg/h and remifentanil（0.04~0.40）μg/kg/min in maintaining the anesthesia depth,and cisatracurium for intermittent muscle relaxation.The patients in the observation group were given venous pumping of dexmedetomidine（1μg/kg）15min before anesthesia induction,and dexmedetomidine（0.2~0.7）μg/kg/h for maintenance until the end of operation.The peripheral venous blood before operation,the time immediately after operation,12 hand 24hafter operation in the two groups was collected.ELISA was used to detect CRP,IL-6,and TNF-α.FCM was used to detect T lymphocyte subsets（CD3^＋,CD4^＋,and CD8^＋）.CD4^＋/CD8^＋were calculated.Ramsay sedation grading was performed before operation,the time immediately after operation,12 hand 24hafter operation.Results：Ramsay sedation score the time immediately after operation and 12 hafter operation in the observation group was significantly greater than that in the control group（P〈0.05）.The serum CRP,IL-6,and TNF-αlevels the time immediately after operation,12 hand 24hafter operation in the observation group were significantly lower than those in the control group（P〈0.05）.The serum CD3^＋,CD4^＋,CD8^＋,and CD4^＋/CD8^＋ the time immediately after operation,12 hand 24hafter operation in the observation group were

关 键 词：右美托咪定 辅助麻醉 老年阿尔茨海默病 髋关节置换术 炎症因子 T淋巴细胞亚群 

分 类 号：R684[医药卫生—骨科学]