右美托咪定辅助椎管内麻醉对老年下肢骨折患者术后应激反应、T淋巴细胞及血清丙二醛、VCAM的影响  

Effects of dexmedetomidine assisted spinal anesthesia on postoperative stress response,T lymphocytes,serum malondialdehyde,and VCAM in elderly patients with lower limb fractures

作　　者：刘涛 刘璇 邢春平 LIU Tao;LIU Xuan;XING Chun-ping(Department of Anesthesiology,General Hospital of Taiyuan Steel(Group)Co.,Ltd,Taiyuan Shanxi 030000,China)

机构地区：[1]太原钢铁(集团)有限公司总医院麻醉科,山西太原030000

出　　处：《临床和实验医学杂志》2024年第4期442-445,共4页Journal of Clinical and Experimental Medicine

基　　金：山西省卫生健康委科研课题(编号:2018196)。

摘　　要：目的探讨右美托咪定(Dex)辅助椎管内麻醉对老年下肢骨折患者术后应激反应、T淋巴细胞及血清丙二醛、血管细胞黏附分子(VCAM)水平的影响。方法前瞻性选取2022年2月至2023年4月太原钢铁(集团)有限公司总医院收治的老年下肢骨折患者106例作为研究对象,按照随机数字表法将其分为观察组和对照组,每组各53例。对照组采用椎管内麻醉,观察组采用Dex辅助椎管内麻醉。比较两组患者术前及术后24 h应激反应指标[去甲肾上腺素(NE)、肾上腺素(E)、皮质醇]、T淋巴细胞亚群(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、血清丙二醛和VCAM水平,比较2组不同时相点血流动力学变化[麻醉前(T_(0))、麻醉30 min后(T_(1))、麻醉60 min后(T_(2))、术毕时(T_(3))的平均脉动压(MAP)和心率]及不良反应发生率。结果术后24 h,两组患者血清NE、E、皮质醇水平均高于手术前,且观察组血清NE、E、皮质醇水平分别为(318.54±82.76)ng/L、(548.58±125.83)pmo/L、(718.57±130.81)nmol/L,均低于对照组[(460.15±102.43)ng/L、(708.55±160.94)pmo/L、(842.26±150.77)nmol/L],差异均有统计学意义(P<0.05)。术后24 h,两组患者CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)值均低于手术前,且观察组CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)值分别为(454.32±72.73)个/μL、(321.95±62.45)个/μL、(1.41±0.33)%,均高于对照组[(321.02±70.14)个/μL、(398.87±86.25)个/μL、(1.29±0.28)%],差异均有统计学意义(P<0.05)。术后24 h,两组患者血清丙二醛、VCAM水平均高于手术前,且观察组血清丙二醛、VCAM水平分别为(198.73±38.68)pg/mL、(41.32±6.14)ng/L,均低于对照组[(215.54±40.76)pg/mL、(58.87±8.43)ng/L],差异均有统计学意义(P<0.05)。两组患者MAP、心率水平在组间、时间点、组间·时间点间交互作用比较差异均有统计学意义(P<0.05)。观察组患者不良反应发生率为13.21%,显著低于对照组(30.19%),差异有统计学意义(P<0.05)。结论Dex辅助用于老年�Objective To investigate the effects of dexmedetomidine(Dex) assisted intraspinal anesthesia on postoperative stress response,T lymphocytes,serum malondialdehyde and vascular Cell adhesion molecule(VCAM) levels in elderly patients with lower limb fractures.Methods A total of 106 elderly patients with lower limb fractures admitted to General Hospital of Taiyuan Steel(Group) Co.,Ltd.from February 2022 to April 2023 were selected and divided into the observation group and the control group according to the random number table method,with 53 patients in each group.The control group received spinal anesthesia,while the observation group received Dex assisted spinal anesthesia.The stress response indicators [norepinephrine(NE),epinephrine(E),cortisol],T-lymphocyte subsets(CD4^(+),CD8^(+),CD4^(+)/CD8^(+)),serum malondialdehyde and VCAM levels were compared between the two groups before surgery and 24 hours after sugery.Hemodynamic changes at different time points[mean pulsatile pressure(MAP) and heart rate before anesthesia(T_(0)),30 minutes after anesthesia(T_(1)),60 minutes after anesthesia(T_(2)),and at postoperative(T_(3))] and the incidence of adverse reactions were compared between the two groups.Results At 24 hours after surgery,the levels of serum NE,E,and cortisol in two groups of patients were higher than those before surgery,and the levels of serum NE,E,and cortisol in the observation group were(318.54±82.76) ng/L,(548.58±125.83) pmo/L,(718.57±130.81) nmol/L,respectively,which were lower than those in the control group[(460.15±102.43) ng/L,(708.55±160.94) pmo/L,(842.26±150.77) nmol/L],the differences were statistically significant(P<0.05).At 24 hours after surgery,the levels of CD4^(+),CD8^(+),CD4^(+)/CD8^(+) in two groups of patients were lower than those before surgery,and the levels of CD4^(+),CD8^(+),CD4^(+)/CD8^(+) in the observation group were(454.32±72.73) cells/μL,(321.95±62.45) cells/μL,(1.41±0.33)%,respectively,which were higher than those in the control group[(321.02±70.14) cells/μL,(3

关 键 词：老年人 T淋巴细胞 丙二醛 右美托咪定 椎管内麻醉 下肢骨折 血管细胞黏附分子 

分 类 号：R614[医药卫生—麻醉学]