不同剂量右美托咪定对老年下肢骨折患者术后认知功能及免疫功能的影响  

The effects of different doses of dexmedetomidine on postoperative cognitive function and immune function in elderly patients with lower limb fractures

作　　者：王晓林[1] 张文超[1] 王庚[1] WANG Xiao-lin;ZHANG Wen-chao;WANG Geng(Department of Anesthesiology,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院麻醉科,北京100035

出　　处：《实用医院临床杂志》2020年第6期7-9,共3页Practical Journal of Clinical Medicine

基　　金：北京积水潭医院青年人才培养“学科新星”计划项目(编号:XKXX201619)。

摘　　要：目的探讨不同剂量右美托咪定对老年下肢骨折患者术后认知功能及免疫功能的影响。方法2015年3月至2017年7月150例老年下肢骨折患者,按照麻醉方案分为A、B、C组各50例。A组静脉泵入右美托咪啶0.5 μg/(kg ·h),B组:右美托咪啶1.0 μg/(kg ·h),C组:生理盐水。全程监测患者生命体征,比较三组术后认知功能障碍(POCD)的发生率以及麻醉前10 min(T0)、术后1 h(T1)、12 h(T2)、48 h(T3)的淋巴细胞(CD3^+ 、CD4^+、CD8^+、CD4^+/CD8^+)。结果C组患者手术后3d MMSE低于A、B组,B组POCD明显低于A组、C组,差异均有统计学意义( P <0.05)。三组患者T1时间点各项免疫指标水平较T0出现下降,至T3逐渐上升,其中B组患者T3时间点CD3^+、CD4^+、CD8^+水平均高于A组、C组,差异有统计学意义( P <0.05)。结论右美托咪啶可改善老年下肢骨折患者免疫功能,1.0 μg/kg对降低POCD 发生率效果较佳。Objective To investigate the effects of different doses of dexmedetomidine on postoperative cognitive function and immune function in elderly patients with lower extremity fractures.Methods The clinical data of 150 elderly patients with lower extremity fractures who were treated in our hospital from March 2015 to July 2017 were retrospectively analyzed.The patients were divided into groups A,B,and C according to the anesthesia program,50 in each group.The group A was given 0.5 μg/(kg ·h) dexmedetomidine,the group B was given 1.0 μg/(kg ·h) dexmedetomidine and the group C was given normal saline.The patient s vital signs were monitored throughout the whole period.Peripheral blood was taken at different times.The incidence of postoperative cognitive dysfunction (POCD) and the levels of lymphocytes (CD3^+ 、CD4^+、CD8^+、CD4^+/CD8^+) before 10 min of anesthesia (T0),after 1 hour (T1),12 hours (T2) and 48 hours (T3) of operation were compared among the three groups.Results The MMSE score after 3 days of operation in the group C was lower than that in the groups A and B ( P <0.05) The incidence of POCD in the group B was significantly lower than that in the group A and the group C ( P <0.05).The levels of various immune indexes in the three groups at T1 were gone down when compared to those at T0,and gradually increased at T3.Among them,the CD3^+,CD4^+,and CD8^+ levels in the group B were higher than those in the groups A and C at time T3 ( P <0.05).Conclusion Dexmedetomidine can improve the immune function in elderly patients with lower extremity fractures.The continuous pumping with 1.0 μg/kg dose is better for reducing the incidence of POCD.

关 键 词：右美托咪定 老年下肢骨折 术后认知功能 应激反应 免疫功能 

分 类 号：R614.2[医药卫生—麻醉学]