右美托咪定辅助腰硬阻滞麻醉对股骨粗隆间骨折患者术后认知功能的影响  

Effect of dexmedetomidine-assisted lumbar block anesthesia on postoperative cognitive function in patients with intertrochanteric fractures

作　　者：秦茂钧 张志军[1] QIN Maojun;ZHANG Zhijun(Department of Anesthesiology,Anyang People′s Hospital of He′nan Province,Anyang 455000,China)

机构地区：[1]河南省安阳市人民医院麻醉科,安阳455000

出　　处：《西北药学杂志》2020年第3期426-430,共5页Northwest Pharmaceutical Journal

基　　金：河南省科技攻关计划项目(编号:182102310149).

摘　　要：目的观察右美托咪定辅助腰硬阻滞麻醉对股骨粗隆间骨折患者术后认知功能的影响。方法选取择期行内固定手术的股骨粗隆间骨折患者92例,按照随机数字表法均分为试验组和对照组。2组均采取腰硬阻滞麻醉,试验组于麻醉成功后15 min内泵入右美托咪定0.4μg·kg-1,而后以0.2μg·kg^-1·h^-1的速度持续输注右美托咪定至手术结束前30 min,对照组采用同样方法输注等量生理盐水。比较2组麻醉前5 min(t 0)、麻醉后10 min(t 1)、术毕时(t 2)和术后1 h(t 3)的血流动力学指标[心率(HR)和平均动脉压(MAP)]、血浆应激反应指标[醛固酮(ALD)和血管紧张素Ⅱ(AngⅡ)]及血清T细胞亚群指标(CD4+/CD8+,CD4+,CD8+)水平,并对比2组不良反应发生率、术后1周认知功能障碍发生率与术前1 d、术后3和7 d的认知功能评分(MMSE)。结果2组t 0时HR及MAP水平比较差异无统计学意义(P>0.05);试验组t 1、t 2和t 3时HR及MAP水平与t 0时比较,差异无统计学意义(P>0.05);试验组t 1、t 2和t 3时HR及MAP水平均低于对照组(P<0.05);2组t 1、t 2和t 3时血浆ALD和AngⅡ水平均较t 0时升高,但试验组均低于对照组(P<0.05);2组t 1、t 2和t 3时血清CD4+/CD8+与CD4+均较t 0时降低,但试验组高于对照组(P<0.05);对照组t 1、t 2和t 3时血清CD8+水平均较t 0时降低,试验组仅t 2时降低,且试验组t 1、t 2和t 3时血清CD8+水平均高于对照组(P<0.05);2组术后3和7 d的MMSE评分均较术前1 d降低,但试验组高于对照组(P<0.05);试验组不良反应发生率及术后1周认知功能障碍发生率分别为13.04%和10.87%,均低于对照组30.43%和28.26%(P<0.05)。结论对行内固定手术的股骨粗隆间骨折患者应用右美托咪定辅助腰硬阻滞麻醉可稳定术中血流动力学,减轻应激反应,减少不良反应发生,且对术后认知功能和免疫功能影响小。Objective To observe the effect of dexmedetomidine-assisted lumbar epidural block anesthesia on postoperative cognitive function in patients with intertrochanteric fracture of femur.Methods 92 patients with femoral intertrochanteric fractures who underwent elective internal fixation were selected as the experimental group and the control group by random number table method.Both groups were treated with lumbar block anesthesia.The experimental group was given dexmedetomidine 0.4μg·kg-1 within 15 min after successful anesthesia,and then continued to infuse dexmedetomidine at the rate of 0.2μg·kg^-1·h^-1 until 30 min before the end of the operation.The control group was given the same amount of saline.The hemodynamic indexes[heart rate(HR)and mean arterial pressure(MAP)],plasma stress response indicators[aldosterone(ALD)and angiotensinⅡ(AngⅡ)]and serum T cell subsets(CD4+/CD8+,CD4+,CD8+)levels of the 2 groups were compared at 5 min before anesthesia(t 0),10 min after anesthesia(t 1),the end of operation(t 2)and 1 h after operation(t 3).The incidence of adverse reactions and cognitive dysfunction 1 week after operation,and cognitive function score(MMSE)1 d before operation,3 d and 7 d after operation of the 2 groups were also compared.Results There was no statistically significant difference in HR and MAP levels at t 0 between the 2 groups(P>0.05).Compared with the level at t 0,there was no statistically significant difference in HR and MAP levels at t 1,t 2 and t 3 in the experimental group(P>0.05).HR and MAP levels at t 1,t 2 and t 3 in the experimental group were lower than that in the control group(P<0.05).The plasma ALD and AngⅡlevels at t 1,t 2 and t 3 in the 2 groups were higher than that at t 0,but the experimental group were lower than that in the control group(P<0.05).Serum CD4+/CD8+and CD4+levels at t 1,t 2 and t 3 in both groups were lower than those at t 0,but the levels in the experimental group were higher than those in the control group(P<0.05).The levels of CD8+at t 1,t 2 and t 3 in the co

关 键 词：右美托咪定 股骨粗隆间骨折 内固定手术 腰硬阻滞麻醉 认知功能 T淋巴细胞亚群 

分 类 号：R971[医药卫生—药品]