右美托咪定对老年下肢骨折患者全身麻醉苏醒期躁动应激反应和免疫功能的影响  

Effects of Dexmedetomidine on Restlessness Stress Response and Immune Function in Elderly Patients with Lower Limb Fractures During Recovery from General Anesthesia

作　　者：李松林[1] 李贤 曾宾[1] 张治明[1] 龙志忠[1] 杨冯睿 LI Songlin;LI Xian;ZENG Bin(The First People's Hospital of Chenzhou City,Hunan Chenzhou 423000,China)

机构地区：[1]湖南省郴州市第一人民医院麻醉科,湖南郴州423000 [2]南华大学附属第一院麻醉科,湖南衡阳421001

出　　处：《河北医学》2021年第12期2096-2100,共5页Hebei Medicine

基　　金：湖南省卫生计生委科研计划课题,(编号:B2016129)。

摘　　要：目的:探讨右美托咪定用于老年下肢骨折患者全身麻醉对其苏醒期躁动、应激反应和免疫功能的影响。方法:选取2020年1月至2020年12月在我院行下肢骨折术的老年患者128例,按照麻醉药物不同分组,给予氯化钠溶液的67例患者纳入对照组,给予右美托咪定的61例患者纳入研究组。采用Riker镇静和躁动评分(RSAS)评估两组患者苏醒期躁动情况,并比较两组应激反应[去甲肾上腺素(NE)、肾上腺素(E)和皮质醇(Cor)]、免疫功能[CD4^(+)、CD4^(+)/CD8^(+)]变化情况以及麻醉苏醒期并发症发生情况。结果:研究组在用药后30min(T1)、用药后60min(T2)、术毕(T3)时RSAS评分明显低于对照组(P<0.05)。两组在T1、T2、T3时E、NE、Cor与术前(T0)比较均升高(P<0.05),但研究组在T2、T3时E、NE、Cor明显低于对照组(P<0.05)。两组在麻醉结束、术后24h、术后48h时CD4^(+)、CD4^(+)/CD8^(+)与麻醉诱导前比较均降低(P<0.05),但研究组明显高于对照组(P<0.05)。研究组躁动发生率(1.64%vs 14.93%)、并发症发生率(18.03%vs 35.82%)明显低于对照组(P<0.05)。结论:右美托咪定用于老年下肢骨折患者全身麻醉,可降低苏醒期躁动,减少术后并发症的发生,减轻应激反应,改善免疫功能。Objective:To explore the effect of general anesthesia of dexmedetomidine used in elderly patients with lower limb fractures on restlessness,stress response and immune function during the recovery period.Methods:A total of 128 elderly patients who underwent lower limb fracture surgery in our hospital from January 2020 to December 2020 were selected.According to different anesthetics,67 patients who were given sodium chloride solution were included in the control group,and 61 patients who were given dexmedetomidine were included in the study group.The Riker Sedation and Restlessness Score(RSAS)was used to assess the agitation of the two groups of patients during the recovery period,and to compare the two groups of stress responses[norepinephrine(NE),epinephrine(E)and cortisol(Cor)],immune function[CD4^(+),CD4^(+)/CD8^(+)]changes and complications during recovery from anesthesia.Results:The RAS score of the study group was significantly lower than that of the control group at 30 min(T1),60 min(T2)and the end of the operation(T3)after treatment(P<0.05).E,NE,and Cor increased at T1,T2,and T3 in the two groups compared with preoperative(T0)(P<0.05),but the E,NE,and Cor in the study group were significantly lower than those in the control group at T2,T3(P<0.05).The levels of CD4^(+)and CD4^(+)/CD8^(+)at the end of anesthesia,24h after operation,and 48h after operation were lower in both groups than before induction of anesthesia(P<0.05),but the study group was significantly higher than the control group(P<0.05).The incidence of restlessness(1.64%vs 14.93%)and the incidence of complications(18.03%vs 35.82%)in the study group were significantly lower than those in the control group(P<0.05).Conclusion:Dexmedetomidine is used for general anesthesia in elderly patients with lower limb fractures,which can reduce restlessness during recovery,reduce postoperative complications,reduce stress response,and improve immune function.

关 键 词：右美托咪定 下肢骨折 全身麻醉 苏醒期躁动 应激反应 免疫功能 

分 类 号：R614[医药卫生—麻醉学]