右美托咪定对行膝关节置换术老年患者的神经、认知功能及炎性因子表达的影响  

Effect of Dexmedetomidine on Neurologic and Cognitive Functions and Inflammatory Factor Expression in Elderly Patients Undergoing Knee Arthroplasty

作　　者：解孝颖 高博 郑炳强 孟梦 庄齐伟 XIE Xiaoying;GAO Bo;ZHENG Bingqiang;MENG Meng;ZHUANG Qiwei(Department of Anesthesiology,Hebei Petro China Central Hospital,Langfang,Hebei 065000,China)

机构地区：[1]河北中石油中心医院麻醉科,河北廊坊065000

出　　处：《临床误诊误治》2024年第15期74-79,90,共7页Clinical Misdiagnosis & Mistherapy

基　　金：廊坊市科技支撑计划项目(2021013150)。

摘　　要：目的探讨右美托咪定对行膝关节置换术老年患者神经、认知功能及炎性因子表达的影响。方法选取2022年3月至2023年3月择期行人工单侧全膝关节置换术的老年患者120例,按随机数字表法分为A、B、C、D组,每组30例。A组予以腰硬联合麻醉,B、C、D组在腰硬联合麻醉基础上于麻醉平面固定后先给予0.50μg/kg负荷剂量右美托咪定,后分别以0.30、0.50、0.80μg/(kg·h)速度持续静脉泵注。比较4组手术前后血清炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)]、脑组织损伤标志物[细胞间黏附分子-1(ICAM-1)、星形胶质源性蛋白(S-100β)]水平、蒙特利尔认知评估量表(MoCA)评分。记录4组术后认知障碍(POCD)发生率及不良反应发生率。结果4组术后1 h、1 d、3 d血清TNF-α、IL-6、IL-10水平均较术前升高,且D组低于A、B、C组,C组低于A、B组(P<0.05)。术后1 h、1 d、3 d,4组血清S-100β、ICAM-1水平均较术前升高,且D组低于A、B、C组,C组低于A、B组(P<0.05)。术后1、3、7 d,A、B组MoCA评分均较术前降低(P<0.05);术后1、3 d,C、D组MoCA评分较术前降低(P<0.05),术后7 d C、D组均恢复至术前水平;术后1、3、7 d D组MoCA评分高于A、B、C组,且C组高于A、B组(P<0.05)。术后3 d,D组POCD发生率低于A、B组,C组POCD发生率低于A组(P<0.05);4组术后低血压、心动过缓发生率比较差异无统计学意义(P>0.05)。结论老年膝关节置换患者术中以每小时0.80μg/kg速率持续泵入右美托咪定在减轻术后炎症损伤、神经功能损伤、认知功能损伤的效果更为显著,并能保障麻醉安全性。Objective To investigate the effects of Dexmedetomidine on neurologic function,cognitive function and expression of inflammatory factors in elderly patients undergoing knee arthroplasty.Methods A total of 120 elderly patients who underwent unilateral total knee arthroplasty(TKA)from March 2022 to March 2023 were selected and divided into groups A,B,C and D by random number table method,with 30 patients in each group.Group A was given combined epidural anesthesia,while groups B,C and D were given combined epidural anesthesia plus Dexmedetomidine;0.50μg/kg load dose of Dexmedetomidine was given after flat fixation,and then intravenous micro-pumping was continued at 0.30,0.50 and 0.80μg/(kg·h),respectively.The levels of serum inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-10(IL-10)],markers of brain tissue injury[intercellular adhesion molecule-1(ICAM-1),astroglia-derived protein(S-100β)]and Montreal Cognitive Assessment Scale(MoCA)scores before and after operation were compared among the four groups.The incidence of postoperative cognitive dysfunction(POCD)and adverse reactions was recorded in the four groups.Results The serum levels of TNF-α,IL-6 and IL-10 in the four groups at 1 h,1 d and 3 d after surgery were higher than those before surgery(P<0.05).The levels of S-100βand ICAM-1 in serum of the four groups at 1 h,1 d and 3 d after surgery were higher than those before surgery,which were lower in group D than in groups A,B and C,and lower in group C than in groups A and B(P<0.05).At 1,3 and 7 d after surgery,MoCA scores in group A and group B were lower than those before surgery(P<0.05).At 1 and 3 d after surgery,MoCA scores in groups C and D were lower than those before surgery(P<0.05),and recovered to the preoperative level in groups C and D at 7 d after surgery.The MoCA score of group D was higher than that of groups A,B and C at 1 d,3 d and 7 d after surgery,and higher in group C than in groups A and B(P<0.05).At 3 d after surgery,the incidence of POCD in group D

关 键 词：右美托咪定 麻醉 膝关节置换术 肿瘤坏死因子-Α 白细胞介素-6 细胞黏附分子-1 星形胶质源性蛋白 认知障碍 

分 类 号：R684[医药卫生—骨科学]