不同剂量右美托咪定对全髋关节置换术患者脑功能、T淋巴细胞免疫功能保护效果及应激反应影响  

Protective Effects of Different Doses of Dexmedetomidine on Brain Function and Immune Function of T Lymphocytes in Patients Undergoing Total Hip Arthroplasty and Its Effect on Stress Response

作　　者：师雄 段炜 SHI Xiong;DUAN Wei(Department of Anesthesiology,Chongqing Orthopaedic Hospital of Traditional Chinese Medicine,Chongqing 400012,China;Department of Neurology,the Second Affiliated Hospital of PLA Army Medical University,Chongqing 400000,China)

机构地区：[1]重庆市中医骨科医院麻醉科,重庆400012 [2]陆军军医大学第二附属医院神经内科,重庆400000

出　　处：《临床误诊误治》2020年第9期67-72,共6页Clinical Misdiagnosis & Mistherapy

基　　金：重庆市社会民生科技创新项目(cstc2015shmszx120106)。

摘　　要：目的探讨不同剂量右美托咪定对全髋关节置换术患者脑功能、T淋巴细胞免疫功能保护效果及应激反应影响。方法选取2016年1月—2018年12月收治的择期行全髋关节置换术80例作为研究对象,根据麻醉药物剂量不同,分为对照组及右美托咪定低、中、高剂量组,每组各20例。所有患者均行常规麻醉,在此基础上,对照组静脉泵注等量的0.9%氯化钠注射液,右美托咪定低、中、高剂量组分别给予0.5μg/(kg·h)、0.75μg/(kg·h)、1.0μg/(kg·h)的右美托咪定持续静脉泵注,均于髋关节囊缝合时停止给药。比较手术相关情况(麻醉平面、手术时间、补液量、出血量、尿量及假体类型),检测术前、术中(皮肤切开后1 h)及术毕血浆神经元特异烯醇化酶(NSE)、S100β及应激反应相关指标[去甲肾上腺素(NE)、肾上腺素(E)及皮质醇(Cor)]水平,观察术前、术毕及术后1 d T淋巴细胞亚群(CD3+、CD4+、CD4+/CD8+)水平,记录围术期不良反应发生情况。结果4组麻醉平面、手术时间、补液量、出血量、尿量及假体类型比较差异无统计学意义(P>0.05)。4组术中、术毕NSE、S100β、NE、E、Cor水平总体比较差异有统计学意义(P<0.05或P<0.01);与对照组同一时间比较,右美托咪定中、高剂量组术中及术毕血浆NSE、S100β、NE、E、Cor水平降低,差异有统计学意义(P<0.05或P<0.01)。4组术毕及术后1 d CD3+、CD4+、CD4+/CD8+水平总体比较差异有统计学意义(P<0.05或P<0.01);与对照组同一时间比较,右美托咪定中、高剂量组术毕及术后1 d CD3+、CD4+、CD4+/CD8+水平升高,差异有统计学意义(P<0.05或P<0.01)。4组围术期均未发生明显不良反应。结论行全髋关节置换术的患者术中静脉滴注右美托咪定具有一定的脑保护作用,可减轻应激反应,提高T淋巴细胞免疫功能,且静脉滴注高剂量右美托咪定的效果最为显著。Objective To explore the protective effects of different doses of Dexmedetomidine on brain function and immune function of T lymphocytes in patients undergoing total hip arthroplasty and its influence on stress response.Methods Eighty patients undergoing elective total hip arthroplasty admitted to our hospital from January 2016 to December 2018 were selected and included in the study.According to different anesthetic drugs,they were divided into control group,low-dose Dexmedetomidine group,medium-dose Dexmedetomidine group and high-dose Dexmedetomidine group with 20 cases in each group.All patients underwent conventional anesthesia.On this basis,the control group received the same amount of 0.9%sodium chloride injection,while low-dose,medium-dose and high-dose Dexmedetomidine groups were continuously and intravenously injected with 0.5μg/(kg·h),0.75μg/(kg·h)and 1.0μg/(kg·h)of Dexmedetomidin,respectively.The administration was withdrawn when the hip joint capsule was sutured.The operation-related indicators(anesthesia level,duration of operation,fluid infusion volume,blood loss,urine volume and prosthesis types)were compared among the four groups.The levels of plasma neuron-specific enolase(NSE),S100βprotein,and levels of stress response-related indicators[norepinephrine(NE),epinephrine(E),and cortisol(Cor)]were measured before operation,during operation(at 1 h after skin incision)and at the end of operation,and the levels of T lymphocyte subsets(CD3+,CD4+,and CD4+/CD8+)were measured before operation,at the end of operation and at 1 d after operation.The occurrence of perioperative adverse reactions was recorded.Results There were no significant differences in anesthesia level,duration of operation,fluid infusion volume,blood loss,urine volume and prosthesis types among the four groups(P>0.05).Significant differences were found in the total levels of plasma NSE,S100β,NE,E and Cor during operation and at the end of operation in the four groups(P<0.05 or P<0.01).Compared with those in the control group at th

关 键 词：关节成形术 置换 髋 右美托咪定 神经元特异烯醇化酶 去甲肾上腺素 肾上腺素 T淋巴细胞亚群 

分 类 号：R614[医药卫生—麻醉学]