右美托咪定联合舒芬太尼术后镇痛对脊柱手术患者应激反应、炎症反应、氧化应激及免疫功能的影响  

Effect of dexmedetomidine combined with sufentanil on stress response,inflammatory response and immune function of patients undergoing spinal surgery

作　　者：杨燕[1] 张运琼 黄沾 王中胜[1] 银西洋 刘志莲[1] YANG Yan;ZHANG Yunqiong;HUANG Zhan;WANG ZhongSheng;YIN Xiyang;Liu Zhilian(Department of Anesthesia,Luzhou Traditional Chinese Medicine Hospital,Luzhou 646000,Sichuan Province,China)

机构地区：[1]泸州市中医医院麻醉科,四川泸州646000

出　　处：《新乡医学院学报》2020年第3期277-281,共5页Journal of Xinxiang Medical University

基　　金：泸州市中医医院科技计划项目(编号:2016-S-61(1/3))。

摘　　要：目的探讨右美托咪定联合舒芬太尼术后镇痛对脊柱手术患者应激反应、炎症反应及免疫功能的影响。方法选择2018年1月至2019年1月于泸州市中医医院进行脊柱手术治疗的98例患者为研究对象,将患者随机分为观察组和对照组,每组49例。对照组患者给予舒芬太尼术后镇痛,观察组患者给予舒芬太尼联合右美托咪定术后镇痛。比较2组患者术毕即刻及术后4、24 h血清促肾上腺皮质激素(ACTH)、皮质醇(Cor)、醛固酮(ALD)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、丙二醛(MDA)、超氧化物歧化酶(SOD)、羟自由基(·OH)和T细胞亚群水平。结果2组患者术毕即刻血清ACTH、Cor、ALD、CRP、TNF-α、MDA、SOD、·OH、CD3+、CD4+、CD8+水平及CD4+/CD8+比值比较差异均无统计学意义(P>0.05)。2组患者术后4、24 h血清ACTH、Cor、ALD、CRP、TNF-α、MDA、·OH水平均低于术毕即刻,SOD水平高于术毕即刻(P<0.05);2组患者术后24 h血清ACTH、Cor、ALD、CRP、TNF-α、MDA、·OH水平均低于术后4 h,SOD水平高于术后4 h(P<0.05)。术后4、24 h,观察组患者血清ACTH、Cor、ALD、CRP、TNF-α、MDA、·OH水平均低于对照组,SOD水平高于对照组(P<0.05)。观察组患者术后4、24 h CD3+、CD4+水平及CD4+/CD8+比值均高于术毕即刻(P<0.05),观察组患者术后24 h CD3+、CD4+水平及CD4+/CD8+比值高于术后4 h(P<0.05),观察组患者术后各时间点CD8+水平比较差异均无统计学意义(P>0.05)。对照组患者术后各时间点CD3+、CD4+、CD8+水平及CD4+/CD8+比值比较差异均无统计学意义(P>0.05)。术后4、24 h,观察组患者CD3+、CD4+水平及CD4+/CD8+比值高于对照组(P<0.05),2组患者CD8+水平比较差异无统计学意义(P>0.05)。结论应用右美托咪定联合舒芬太尼术后镇痛能够有效减轻脊柱手术患者的应激反应与炎症反应,保护患者的免疫功能。Objective To investigate the effect of dexmedetomidine combined with sufentanil on stress response,inflammatory response and immune function of patients undergoing spinal surgery.Methods Ninety eight patients who underwent spinal surgery in Luzhou Traditional Chinese Medicine Hospital from January 2018 to January 2019 were selected and randomly divided into observation group(n=49)and control group(n=49).The patients in the control group were given sufentanil for postoperative analgesia,the patients in the observation group were given sufentanil combined with dexmedetomidine for postoperative analgesia.The levels of serum adrenocorticotropic hormone(ACTH),cortisol(Cor),aldosterone(ALD),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),malondialdehyde(MDA),superoxide dismutase(SOD),hydroxyl radical(·OH)and T cell subsets were compared between the two groups at immediately after operation and 4,24 hours after operation.Results There was no significant difference in the levels of serum ACTH,Cor,ALD,CRP,TNF-α,MDA,SOD,·OH,CD3+,CD4+,CD8+and the ratio of CD4+/CD8+between the two groups at immediately after operation(P>0.05).The levels of serum ACTH,Cor,ALD,CRP,TNF-α,MDA,·OH at 4,24 hours after operation were lower than those at immediately after operation in the two groups(P<0.05),and the level of SOD was higher than that at immediately after operation(P<0.05);The levels of serum ACTH,Cor,ALD,CRP,TNF-α,MDA,·OH at 24 hours after operation were lower than those at 4 hours after operation in the two groups(P<0.05),and the level of SOD was higher than that at 4 hours after operation(P<0.05).At 4,24 hours after operation,the levels of serum ACTH,Cor,ALD,CRP,TNF-α,MDA and·OH of patients in the observation group were lower than those in the control group(P<0.05),and the level of SOD in the observation group was higher than that in the control group(P<0.05).The levels of CD3+,CD4+and the ratio of CD4+/CD8+at 4,24 hours after operation were higher than those immediately after operation in the observation group(P<0

关 键 词：右美托咪定 脊柱 应激反应 炎症反应 免疫功能 

分 类 号：R614[医药卫生—麻醉学]