右美托咪定联合舒芬太尼对老年下肢骨折手术患者全麻苏醒期血流动力学及应激状态的影响  

Effects of Dexmedetomidine combined with Sufentanil on the hemodynamics and stress state in the wake of general anesthesia in elderly patients with lower limb fracture surgery

作　　者：童华[1,2] 王庭辉 王欣路 吴涛 李爽 TONG Hua;WANG Ting-hui;WANG Xin-lu;WU Tao;LI Shuang(Department of Anesthesia,First Affiliated Hospital of Xi 'an Jiaotong University,Xi'an 710061,Shaanxi,China;Department of Anesthesia,Ali people's Hospital,Ali region,Tibet 859400,China;Department of Neurology,The First Affiliated Hospital of Xi'an Medical College,Xi'an 710061,Shaanxi,China)

机构地区：[1]西安交通大学第一附属医院麻醉科,陕西西安710061 [2]阿里地区人民医院麻醉科,西藏阿里地区859400 [3]西安医学院第一附属医院神经外一科,陕西西安710061

出　　处：《海南医学院学报》2019年第13期1021-1025,共5页Journal of Hainan Medical University

基　　金：陕西省自然科学基础研究计划项目(2017JD1203)~~

摘　　要：目的:研究右美托咪定联合舒芬太尼对老年下肢骨折手术患者全麻苏醒期血流动力学、应激状态、辅助T细胞因子及疼痛程度的影响。方法:收集2017年6月~2018年7月于西安交通大学第一附属医院接受骨折手术并实施全麻的老年下肢骨折患者95例,根据其麻醉方式不同,分为舒芬太尼维持麻醉组(舒芬太尼组)46例,右美托咪定联合舒芬太尼维持麻醉组(联合组)49例。在整个手术过程中时刻监测两组患者不同时刻血流动力学指标心率(HR)、血氧饱和度(SpO2)和平均动脉压(MAP)的变化,并采用酶联免疫法检测两组患者在麻醉维持中及麻醉苏醒期应激状态指标皮质醇(Cor)、肾上腺素(E)、胰岛素(FIns)的变化,计算胰岛素抵抗指数(HOMA-IR)。比较2组患者术前及手术完成24h后,疼痛介质一氧化氮(NO)、内啡肽(β-EP)、P物质(SP)及辅助T细胞因子γ-干扰素(IFN-γ)、肿瘤坏死因子-α(TNF-α)的变化。结果:联合组患者HR、SpO2、MAP和舒芬太尼组患者的SpO2在麻醉过程中变化程度较小,差异无统计学意义(P>0.05),舒芬太尼组患者T2、T3的HR和MAP与其T0时差异显著,且显著高于联合组T2、T3时HR和MAP,差异具有统计学差意义(P<0.05)。2组患者麻醉苏醒期应激指标Cor、E、FIns及HOMA-IR水平均显著高于麻醉维持时,差异具有统计学意义(P<0.05),联合组患者苏醒期血清应激指标Cor、E、FIns、HOMA-IR水平均显著低于舒芬太尼组。联合组患者手术后24h辅助T细胞因子IFN-γ水平显著高于舒芬太尼组,TNF-α水平显著低于对照组患者,差异具有统计学意义(P<0.05)。2组患者手术后24h血清疼痛介质NO、β-EP、SP水平均显著高于手术前,差异具有统计学意义(P<0.05),且联合组患者手术前及手术后24h血清疼痛介质NO、β-EP、SP均显著低于舒芬太尼组,差异具有统计学意义(P<0.05)。结论:右美托咪定联合舒芬太尼可稳定老年下肢骨折手术患者全麻苏醒期�Objective: In this study,the effects of Dexmedetomidine combined with Sufentanil on hemodynamics,stress state,helper T cytokines and pain degree during the waking period of general anesthesia in elderly patients with lower limb fracture surgery were studied. Methods: From June 2017 to July 2018,95 elderly patients with lower limb fracture who visited First Affiliated Hospital of Xi 'an Jiaotong University and received fracture surgery and general anesthesia were collected.According to their different anesthesia Methods 46 patients were divided into the sufentanil maintenance anesthesia group (Sufentanil group),and 49 patients were divided into the metopidine combined with sufentanil maintenance anesthesia group (Joint group).Changes in hemodynamics (HR,SpO 2,MAP) of the two groups were monitored at different times throughout the operation.Using enzyme-linked immunoassay detection of two groups of patients in maintain anesthesia and anesthesia to stress index (Cor,E,FIns and HOMA-IR).The the changes of pain mediators (NO,β-EP,SP) and helper T cytokines (IFN-γ,TNF-α) were compared between the two groups before and 24 hours after surgery. Results: In the combined group,HR,SpO 2,MAP and sufentanil groups showed little change in SpO 2 during anesthesia,with no significant difference ( P >0.05).The HR and MAP of T2 and T3 in the sufentanil group were significantly higher than those in the combined group at T2 and T3 ( P <0.05).The stress indicators Cor,E,FIns and HOMA-IR in the anesthesia of the two groups were significantly higher than those in the anesthesia maintenance ( P <0.05).The serum stress indexes of Cor,E,FIns and HOMA-IR were significantly lower in the combined group than in the sufentanil group.The IFN-γ level of the combined group was significantly higher than that of the sufentanil group,and the TNF-α level was significantly lower than that of the control group ( P <0.05).Serum levels of NO,β-EP and SP were significantly higher in the two groups 24 h after surgery ( P <0.05).Serum pain mediators NO

关 键 词：右美托咪定 舒芬太尼 下肢骨折 全麻 苏醒期 

分 类 号：R614[医药卫生—麻醉学]