曲马多对全身麻醉脊柱手术患者红细胞免疫功能、认知功能、拔管反应的影响  

Effects of tramadol on erythrocyte immune function,cognitive function,and extubation response in patients undergoing spinal surgery under general anesthesia

作　　者：闵光炜 李瑾[1] 王江[1] 吴建江[1] Min Guangwei;Li Jin;Wang Jiang;Wu Jianjiang(Department of Anesthesiology,the First Affiliated Hospital of Xinjiang Medical University,Xinjiang Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院麻醉科,新疆乌鲁木齐830054

出　　处：《中国医刊》2023年第10期1103-1106,共4页Chinese Journal of Medicine

基　　金：新疆维吾尔自治区卫生健康青年医学科技人才专项基金(WJWY-202207)。

摘　　要：目的 探讨曲马多对全身麻醉脊柱手术患者红细胞免疫功能、认知功能、拔管反应的影响。方法 选取2021年6月至2022年4月新疆医科大学第一附属医院收治的100例拟进行脊柱手术的患者为研究对象,采用随机数字表法分为对照组和观察组,每组50例。两组患者均采取全身麻醉,手术结束前30min,观察组静脉滴注曲马多(剂量2mg/kg),对照组静脉注射0.9%氯化钠溶液(剂量2mg/kg)。比较分析两组患者术后不同时间点的疼痛程度和镇静程度,手术前后的红细胞免疫功能[红细胞免疫复合物花环率(immune complex rosette,ICR)、协同肿瘤红细胞花环率(synergistic tumor erythrocyte rosette assay,ATER)]、认知功能,苏醒情况,拔管反应以及术后不良反应发生情况。结果 术后6、12、24、48h,观察组患者的视觉模拟评分法评分均显著低于对照组(P<0.05),Ramsay镇静评分均显著高于对照组(P<0.05)。与术前比较,两组患者术后24h的ICR水平均显著升高(P<0.05),且对照组显著高于观察组(P<0.05);两组患者术后24h的ATER、简易智能精神状态检查量表评分均显著降低(P<0.05),且对照组显著低于观察组(P<0.05)。观察组患者术后24h的认知功能障碍发生率显著低于对照组(P<0.05)。两组患者的拔管时间、呼唤睁眼时间、自主呼吸恢复时间比较差异均无显著性(P>0.05)。观察组患者的拔管反应总发生率以及术后不良反应总发生率均显著低于对照组(P<0.05)。结论 曲马多对全身麻醉脊柱手术患者的镇静、镇痛效果均较佳,可显著改善患者的认知功能障碍,减少拔管反应和术后不良反应的发生,且对红细胞免疫功能的影响较小。Objective To investigate the effects of tramadol on erythrocyte immune function,cognitive function,and extubation response in patients undergoing spinal surgery under general anesthesia.Method 100 patients undergoing spinal surgery in the First Affiliated Hospital of Xinjiang Medical University from June 2021 to April 2022 were selected as the study objects.They were divided into control group and observation group by random number table method,with 50 cases in each group.Patients in both groups were given general anesthesia.30min before the end of the surgery,the observation group was given 2mg/kg tramadol intravenously,and the control group was given 2mg/kg 0.9%sodium chloride solution intravenously.The pain degree and sedation degree at different time points,erythrocyte immune function(ICR,ATER)and cognitive function before and after surgery,recovery,extubation response,and postoperative adverse reactions were compared and analyzed between the two groups.Result At 6,12,24,48h after surgery,the VAS score of the observation group was lower than that of the control group(P<0.05),and the Ramsay sedation score was higher than that of the control group(P<0.05).Compared with before surgery,the ICR of two groups was significantly increased at 24h after surgery(P<0.05),and the control group was significantly higher than the observation group(P<0.05).The ATER and MMSE score at 24h after surgery were significantly decreased in two groups(P<0.05),and the control group was significantly lower than the observation group(P<0.05).The incidence of cognitive dysfunction in observation group at 24h after surgery was significantly lower than that in control group(P<0.05).There were no significant differences in extubation time,eye-opening time and recovery time of spontaneous respiration between the two groups(P>0.05).The total incidence of extubation reaction and postoperative adverse reactions in observation group were significantly lower than those in control group(P<0.05).Conclusion The application of tramadol in patients und

关 键 词：曲马多 全身麻醉 脊柱手术 红细胞免疫功能 认知功能 拔管反应 

分 类 号：R614[医药卫生—麻醉学]