不同剂量右美托咪定对腰椎手术自体血回输患者炎症反应、氧化应激反应的影响研究  

A study of the effect of different doses of dexmedetomidine on inflammatory reaction and oxidative stress in patients undergoing autologous blood transfusion for lumbar spine surgery

作　　者：张秀青 王超[1] 杨艳芳 鲍淑敏 张丹 ZHANG Xiu-qing;WANG Chao;YANG Yan-fang(Department of Anesthesiology,Cangzhou Central Hospital,Cangzhou Hebei 061000,China)

机构地区：[1]沧州市中心医院麻醉科,河北沧州061000

出　　处：《临床和实验医学杂志》2024年第22期2461-2464,F0003,共5页Journal of Clinical and Experimental Medicine

基　　金：2021年度河北省医学科学研究课题计划项目(编号:20210871)。

摘　　要：目的研究不同剂量右美托咪定对腰椎手术自体血回输患者炎症反应、氧化应激反应的影响。方法前瞻性选取2021年1月至2022年12月在沧州市中心医院接受腰椎手术,并进行自体血回输的120例患者为研究对象,按照简单随机法将其分为对照组和观察组,每组各60例。对照组给予0.5μg/kg负荷剂量的右美托咪定持续输注15 min,后以0.5μg/kg维持,观察组给予1.0μg/kg负荷剂量的右美托咪定持续输注15 min,后以1.0μg/kg维持。比较麻醉诱导前(T_(0))、自体输血前(T_(1))、自体输血后1 h(T_(2))、自体输血后6 h(T_(3))、自体输血后12 h(T_(4))两组患者炎症因子[白细胞介素(IL)-1β、IL-6、IL-8、肿瘤坏死因子-α(TNF-α)]、氧化应激反应因子[丙二醛、超氧化物歧化酶(SOD)]的差异,记录两组患者自控静脉镇痛(PCIA)按压次数、补救镇痛次数及术后48 h视觉模拟评分法(VAS)评分,统计两组术后5 d内发生率及术后认知功能障碍(POCD)。结果T_(1)、T_(2)、T_(3)、T_(4)时,两组IL-1β、IL-6、IL-8、TNF-α水平均较T_(0)时升高,差异均有统计学意义(P<0.05);观察组T_(1)、T_(2)、T_(3)、T_(4)时的IL-1β、IL-6、IL-8、TNF-α水平均低于对照组,差异均有统计学意义(P<0.05)。T_(1)、T_(2)、T_(3)、T_(4)时,两组丙二醛均较T_(0)时升高,SOD均较T_(0)时降低,观察组T_(1)、T_(2)、T_(3)、T_(4)时的丙二醛低于对照组,SOD高于对照组,差异均有统计学意义(P<0.05);观察组T_(1)、T_(2)、T_(3)、T_(4)时丙二醛低于对照组,SOD高于对照组,差异均有统计学意义(P<0.05)。观察组术后48 h内PCIA按压次数、补救镇痛次数及术后48 h VAS评分分别为(19.05±3.74)次、(1.87±0.21)分、(1.71±0.20)次,均低于对照组[(21.12±4.28)次、(2.12±0.25)分、(1.93±0.21)次],术后5 d的POCD发生率为3.33%,低于对照组(15.00%),差异均有统计学意义(P<0.05)。观察组窦性心动过缓、低血压、低氧血症等累计并发症发生率与对照组Objective To study the effect of different doses of dexmedetomidine on inflammatory reaction and oxidative stress in patients undergoing autologous blood transfusion for lumbar spine surgery.Methods A total of 120 patients undergoing lumbar spine surgery and autologous blood transfusion in Cangzhou Central Hospital from January 2021 to December 2022 were prospectively selected as the research objects.They were divided into the control group and the observation group according to simple random method,60 cases in each group.The control group received a loading dose of 0.5μg/kg dexmedetomidine administered over 15 minutes followed by maintenance of 0.5μg/kg.The observation group received a loading dose of 1.0μg/kg dexmedeto-midine administered over 15 minutes followed by maintenance of 1.0μg/kg.The levels of inflammatory factors[interleukin(IL)-1β,IL-6,IL-8,tumor necrosis factor-α(TNF-α)]and oxidative stress factors[maleic dialdehyde,superoxide dismutase(SOD)]were compared before induction of anesthesia(T_(0)),before autologous transfusion(T_(1)),1 hour after autologous transfusion(T_(2)),6 hours after autologous transfusion(T_(3)),and 12 hours after autologous transfusion(T_(4)).The number of patient controlled intravenous analgesia(PCIA)presses,remedial analgesia with in 48 h after operation and the visual analog scale(VAS)scores on the 48 h after operation were recorded.The postoperative cognitive dysfunction(POCD)with 5 d after operation of the two groups were recorded,and complications were also recorded and compared between the groups.Results At T_(1),T_(2),T_(3) and T_(4),the levels of IL-1β,IL-6,IL-8 and TNF-αin the two groups were higher than those at T_(0),and the levels of IL-1β,IL-6,IL-8 and TNF-αat T_(1),T_(2),T_(3) and T_(4) in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).At T_(1),T_(2),T_(3) and T_(4),the maleic dialdehyde of the two groups was higher than that at T_(0),and the SOD was lower than that at T_(0),an

关 键 词：自体血回输 右美托咪定 炎症反应 氧化应激反应 腰椎手术 不良反应 认知功能障碍 

分 类 号：R614[医药卫生—麻醉学]