右美托咪定联合瑞芬太尼对髋关节置换术老年患者S-100β和高迁移率族蛋白B1的影响  

Effect of dexmetomidine combined with remifentanil on serum S-100β and progrss in high mobility group box-1 levels in hip arthroplasty elderly patients under general anesthesia

作　　者：支燕[1] 赵满意 顾羊林[2] ZHI Yan;ZHAO Manyi;GU Yanglin(Department of Anesthesiology,the Second People′s Hospital of Wuxi,Wuxi 214000,China;Department of Orthopaedics,the Second People′s Hospital of Wuxi,Wuxi 214000,China)

机构地区：[1]无锡市第二人民医院麻醉科,无锡214000 [2]无锡市第二人民医院骨科,无锡214000

出　　处：《西北药学杂志》2019年第6期806-810,共5页Northwest Pharmaceutical Journal

基　　金：无锡市卫生局科研项目(编号:Q201407)

摘　　要：目的研究右美托咪定联合瑞芬太尼治疗全身麻醉下髋关节置换术老年患者的疗效及其对患者血清S-100β和高迁移率族蛋白B1(HMGB1)水平的影响。方法选取拟行髋关节置换术老年患者80例,按照随机数字表法分为对照组和观察组,每组40例。对照组给予瑞芬太尼进行全身麻醉诱导及维持,观察组给予瑞芬太尼及右美托咪定进行全身麻醉维持及诱导。观察比较2组患者的简易精神状态评价量表(MMSE)评分、术后睁眼时间、拔管时间、呼吸恢复时间、S-100β水平、HMGB1水平及不良反应。结果术后1 d,2组患者的MMSE评分比较差异无统计学意义(P>0.05),观察组的术后认知功能障碍(POCD)发生率低于对照组(P<0.05)。术后3 d及术后7 d,观察组的MMSE评分高于对照组,POCD发生率低于对照组(P<0.05)。2组患者的拔管时间、睁眼时间及恢复呼吸时间差异无统计学意义。术前2组患者的S-100β及HMGB1水平相当,但术毕及术后1 d,观察组的S-100β及HMGB1水平均低于对照组(P<0.05)。2组患者的不良反应发生率差异无统计学意义。结论右美托咪定联合瑞芬太尼用于全身麻醉下髋关节置换术老年患者具有良好的效果,可有效减轻患者的POCD和术后炎症反应,且安全性高。Objective To Study the efficacy of dexmetomidine combined with remifentanil in the treatment of hip arthroplasty under general anesthesia and its effect on serum S-100βand progrss in high mobility group box-1(HMGB1)levels in elderly patients.Methods A total of 80 elderly patients with hip arthroplasty were selected and divided into control group and observation group according to random digital table method,with 40 cases in each group.The control group were given remifentanil for general anesthesia induction and maintenance,the observation group were given remifentanil and dexmetomidine for general anesthesia maintenance and induction.The simple mental state examination scale(MMSE)score,postoperative eye opening time,extubation time,respiratory recovery time,S-100βlevel,HMGB1 level and adverse reactions were observed and compared between the 2 groups.Results There was no significant difference in MMSE score between the 2 groups on the first day after operation(P>0.05).The incidence of POCD in the observation group was lower than that in the control group(P<0.05).On the 3rd and 7th day after operation,the MMSE score of the observation group was higher than that of the control group,and the incidence of POCD was lower than that of the control group(P<0.05).There was no significant difference in extubation time,eye opening time and respiratory recovery time between the 2 groups.The levels of S-100βand HMGB1 were similar in the 2 groups before operation,but the levels of S-100βand HMGB1 in the observation group were lower than those in the control group at the end of operation and 1 d after operation(P<0.05).There was no significant difference in the incidence of adverse reactions between the 2 groups.Conclusion Dexmetomidine combined with remifentanil has a good effect on hip arthroplasty in elderly patients under general anesthesia.It can effectively reduce postoperative cognitive dysfunction and reduce postoperative inflammatory reaction with high safety.

关 键 词：右美托咪定 瑞芬太尼 全身麻醉 髋关节置换术 S-100Β 高迁移率族蛋白B1 

分 类 号：R971[医药卫生—药品]