不同剂量右美托咪定联合舒芬太尼对全髋关节置换术患者术中及术后的影响  

Effects of different doses of dexmedetomidine combined with sufentanil on intraoperative and postoperative outcomes of total hip arthroplasty

作　　者：陶芸生[1] 江昭林[2] 甘泉[2] 吴向南[1] TAO Yun-sheng;JIANG Zhao-lin;Gan Quan;WU Xiang-nan(Department of Anesthesiology,Anqing Naval Hospital,Anqing,Anhui,246003,China)

机构地区：[1]中国人民解放军海军安庆医院麻醉科,安徽246003 [2]中国人民解放军海军安庆医院骨科,安徽246003

出　　处：《中国骨与关节杂志》2021年第7期527-532,共6页Chinese Journal of Bone and Joint

摘　　要：目的探讨不同剂量右美托咪定(dexmedetomidine,DEX)辅助全身麻醉对全髋关节置换术(total hip arthroplasty,THA)术中血流动力学、疼痛、认知功能及炎症反应的影响。方法选取我院在2016年10月至2020年10月收治的195例因老年髋部骨折行THA治疗的患者。根据随机数字表法分为D1组(n=65)、D2组(n=65)及D3组(n=65)。所有患者均采取常规全身麻醉。在麻醉诱导前,三组静脉输注DEX,剂量分别为0.25μg/kg、0.50μg/kg及1.00μg/kg,输注10 min。比较三组血流动力学、镇痛效果、认知功能、炎症反应及并发症。结果在T1、T2、T3、T4、T5时间点,D3组及D2组的心率(heart rate,HR)、舒张压(diastolic blood pressure,DBP)及收缩压(systolic blood pressure,SBP)均低于D1组(P<0.05),D3组的HR、DBP及SBP均低于D2组(P<0.05)。在T1、T2、T3、T4、T5、T6时间点,D3组及D2组的疼痛视觉模拟评分(visual analogue scale,VAS)均低于D1组(P<0.05),D3组VAS评分低于D2组(P<0.05),在T7时间点,三组VAS评分比较差异无统计学意义(P>0.05)。在T1、T2、T3、T4时间点,D3组及D2组的简易精神状态量表(simple mental state scale,MMSE)均高于D1组(P<0.05),D3组的MMSE高于D2组(P<0.05)。D3组认知功能障碍发生率低于D1组及D2组(P<0.05);D2组认知功能障碍发生率低于D1组(P<0.05)。在T2、T3、T4时间点,D3组及D2组的C-反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)及白介素-10(interleukin-10,IL-10)浓度均高于D1组(P<0.05),D3组的CRP、TNF-α、IL-10浓度均高于D2组(P<0.05)。D3组并发症总发生率高于D1组及D2组(P<0.05),D2组并发症总发生率高于D1组(P<0.05)。其中D3组并发症主要集中在心动过缓(13.8%)及低血压(15.4%)。结论1.00μg/kg DEX可以有效降低THA患者术后疼痛,减轻炎症反应,改善认知功能,但是0.50μg/kg DEX更能维持术中血流动力学稳定性。Objective To investigate the effects of different dosages of dexmedetomidine(DEX)on hemodynamics,pain,cognitive function and inflammatory response in patients undergoing total hip arthroplasty(THA)under general anesthesia.Methods From October 2016 to October 2020,195 patients after THA due to senile hip fracture were selected.According to the random number table method,all were divided into group D1(n=65),group D2(n=65)and group D3(n=65).All patients received routine general anesthesia.Before anesthesia induction,DEX was administered intravenously in group D1(0.25μg/kg),D2(0.50μg/kg)and D3(1.00μg/kg)for 10 min.Hemodynamics,analgesic effect,cognitive function,inflammatory response and complications were compared among the three groups.Results At time points of T1,T2,T3,T4 and T5,heart rate(HR),diastolic blood pressure(DBP)and systolic blood pressure(SBP)of patients in group D2 and D3 were lower than those in D1 group(P<0.05).HR,DBP and SBP of patients in group D3 were lower than those in D2(P<0.05).At time points T1,T2,T3,T4,T5 and T6,VAS of group D3 and D2 were significantly lower than that of the D1(P<0.05),while those of group D3 were lower than D2(P<0.05).At time point T7,there were no statistically significant differences in the VAS among three groups(P>0.05).At the time points of T1,T2,T3 and T4,simple mental state scale(MMSE)of group D3 and D2 were higher than that of the D1(P<0.05),and the MMSE of D3 was higher than that of the D2(P<0.05).The incidence of cognitive dysfunction in group D3 was lower than that in group D1 and D2(P<0.05),and the incidence in group D2 was lower than that in D1(P<0.05).At the time points of T2,T3 and T4,concentrations of CRP,TNF-αand IL-10 in group D3 and D2 were all higher than that in D1(P<0.05),while the indexes above in the D3 were all higher than that in the D2(P<0.05).The total incidence of complications in group D3 was higher than that in D1 and D2(P<0.05),while that in D2 was higher than those in D1(P<0.05).Major complications of group D3 included bradycardia(13.8%)

关 键 词：右美托咪定 关节成形术 置换 髋 血流动力学 疼痛 认知 

分 类 号：R687.4[医药卫生—骨科学]