麻醉诱导期小剂量地塞米松治疗对老年骨科患者术后免疫功能的影响  

Effect of low-dose dexamethasone therapy on postoperative immune function in elderly orthopedic patients during anesthesia induction

作　　者：尹磊 梁宵 胡义凤[1] 潘云松[1] YIN Lei;LIANG Xiao;HU Yifeng;PAN Yunsong(Department of Anesthesiology,Second People’s Hospital of Wuxi,Affiliated Central Hospital of Jiangnan University,Wuxi Jiangsu 214002,China)

机构地区：[1]无锡市第二人民医院/江南大学附属中心医院麻醉科,江苏无锡214002

出　　处：《临床与病理杂志》2023年第8期1533-1538,共6页Journal of Clinical and Pathological Research

基　　金：无锡市卫生健康委科研项目(Q202036)。

摘　　要：目的:老年患者常伴随机体免疫功能下降,本研究探讨麻醉诱导期给予小剂量地塞米松对老年患者术后免疫功能的影响,以便指导围手术期合理用药。方法:择期老年骨科患者80例,采用随机数字表法将患者分为地塞米松组(诱导期给予地塞米松磷酸钠注射液5 mg)和常规诱导组(常规诱导用药)。患者于麻醉诱导前(T0)、术后12 h(T1)、24 h(T2)、48 h(T3)时间点抽取静脉血,采用流式细胞仪检测辅助T细胞(CD4+)与细胞毒性T细胞(CD8^(+))的比值和自然杀伤细胞(natural killer cells,NK)的百分比。比较2组患者恶心呕吐、过敏反应、伤口感染等不良反应的发生率。结果:2组患者T0时外周血CD4^(+)/CD8^(+)比值比较,差异无统计学意义(P>0.05);2组患者T1时的CD4^(+)/CD8^(+)比值比较,差异有统计学意义(P<0.05);2组患者T1时CD4+/CD8+较T0比值变化大,差异有统计学意义(P<0.05);2组患者T1时的NK细胞的百分比比较,差异有统计学意义(P<0.05);2组T1时NK细胞的百分比与T0时比较,差异有统计学意义(P<0.05);地塞米松组恶心呕吐的发生率明显低于常规诱导组(P<0.05);地塞米松组不良事件的总发生率明显低于常规诱导组(P<0.05)。结论:麻醉诱导期给予小剂量地塞米松,可改善老年术后患者免疫功能,同时减少术后恶心呕吐、肺部感染、伤口感染等不良反应的总发生率。Objective:To investigate the impact of administering low-dose dexamethasone during the anesthesia induction phase on the postoperative immune function of elderly patients,and to provide guidance for the appropriate medication during the perioperative period.Methods:A total of 80 elderly orthopedic patients were randomly divided into a dexamethasone group(administered with 5 mg of dexamethasone during the induction phase)and a routine induction group(treated with routine induction medications).Venous blood samples were collected from patients at various points,including before anesthesia induction(T0),12 h(T1),24 h(T2),48 h(T3)postoperatively.Flow cytometry was employed to measure the ratio of T helper cells(CD4^(+))to cytotoxic T cells(CD8+)and the percentage of natural killer(NK)cells.Incidence of nausea,vomiting,allergic reactions,and wound infections were compared between the 2 groups.Results:The general condition of patients of the 2 groups showed no statistically significant differences(P>0.05).At T1,the CD4^(+)/CD8^(+)ratio showed a significant difference(P<0.05).The ratio of CD4^(+)/CD8^(+)at T1 was significantly higher than that at T0(P<0.05).The comparison of the percentage of NK cells at T1 between the 2 groups showed a statistically significant difference(P<0.05).The percentage of NK cells in T1 was significantly different from that in T0(P<0.05).The incidence of nausea and vomiting in the dexamethasone group was significantly lower than that in the routine induction group(P<0.05).The overall incidence of adverse events in the dexamethasone group was significantly lower than that in the routine induction group(P<0.05).Conclusion:Administering low-dose dexamethasone during anesthesia induction phase can improve the immune function of elderly postoperative patients,and reduce the overall incidence of postoperative nausea,vomiting,allergic reactions and wound infection.

关 键 词：地塞米松 老年骨科手术 免疫功能 麻醉诱导 

分 类 号：R614[医药卫生—麻醉学]