右美托咪定对腰椎手术自体血回输患者炎症应激反应及认知功能的影响研究  

Effect of dexmedetomidine on inflammatory stress response and cognitive function in patients with autologous blood transfusion for lumbar surgery

作　　者：王超[1] 张秀青 杨艳芳 鲍淑敏 张丹 WANG Chao;ZHANG Xiu-qing;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23期2573-2576,F0003,共5页Journal of Clinical and Experimental Medicine

基　　金：河北省自然科学基金资助项目(编号:C2019405091)。

摘　　要：目的探讨右美托咪定对腰椎手术自体血回输患者炎症应激反应的影响。方法前瞻性选取2021年1月至2022年12月在沧州市中心医院行腰椎手术自体血回输患者120例作为研究对象,按照信封法将患者分为观察组(n=60)和对照组(n=60)。观察组给予右美托咪定持续泵注,对照组给予等量0.9%氯化钠溶液泵注。观察两组术中指标(手术时间、术中出血量),麻醉前30 min(T_(0))、自体血回输6 h(T_(1))、自体血回输12 h(T_(2))和自体血回输24 h(T_(3))时白细胞介素(IL)-1β、IL-6、肿瘤坏死因素-α(TNF-α)、皮质醇、去甲肾上腺素(NE)、肾上腺素(E)的差异,手术前后易智力状态检查量表(MMSE)变化和术后认知功能障碍(POCD)发生情况。结果两组的手术时间、术中出血量、回输血量和补液量比较,差异均无统计学意义(P>0.05)。T_(1)、T_(2)和T_(3)时,两组IL-1β、IL-6和TNF-α水平均较T_(0)升高,差异均有统计学意义(P<0.05);观察组T_(1)、T_(2)和T_(3)时IL-1β、IL-6和TNF-α水平均明显低于对照组,差异均有统计学意义(P<0.05)。T_(1)、T_(2)时,两组皮质醇水平均较T_(0)升高,T_(3)时,两组皮质醇较T_(0)降低,T_(1)、T_(2)、T_(3)时,两组NE和E水平均较T_(0)升高,差异均有统计学意义(P<0.05);观察组T_(1)、T_(2)和T_(3)时皮质醇、NE和E水平均明显低于对照组,差异均有统计学意义(P<0.05)。术后1 d时,两组MMSE评分均较术前降低,且观察组术后1 d时MMSE评分为(26.06±1.00)分,高于对照组[(24.82±0.98)分],差异均有统计学意义(P<0.05)。观察组POCD发生率为3.33%,低于对照组(20.00%),差异有统计学意义(P<0.05)。结论右美托咪定有助于缓解腰椎手术自体血回输患者炎症应激反应,对患者认知功能有一定保护作用。Objective To explore the effect of dexmedetomidine on inflammatory stress response in patients undergoing lumbar spine surgery with autologous blood transfusion.Methods A total of 120 patients undergoing autologous blood transfusion for lumbar spine surgery in Cangzhou Central Hospital from January 2021 to December 2022 were prospectively selected as the study subjects.The patients were divided into the observation group(n=60)and the control group(n=60)according to the envelope method.The observation group was given continuous pumping of dexmedetomidine,and the control group was given pumping of the same amount of 0.9%sodium chloride solution.The intraoperative indexes(operation time,intraoperative blood loss),the differences of interleukin(IL)-1β,IL-6,tumor necrosis factor-α(TNF-α),cortisol,norepinephrine(NE)and epinephrine(E)at 30 minutes before anesthesia(T_(0)),6 hours after autologous blood transfusion(T_(1)),12 hours after autologous blood transfusion(T_(2)),and 24 hours after autologous blood transfusion(T_(3)),the changes of mini-mental state examination(MMSE)before and after operation and the occurrence of postoperative cognitive dysfunction(POCD)were observed.Results There were no statistically significant differences in operation time,intraoperative blood loss,blood transfusion and fluid infusion between the two groups(P>0.05).At T_(1),T_(2)and T_(3),the levels of IL-1β,IL-6 and TNF-αin the two groups were higher than those at T_(0),and the differences were statistically significant(P<0.05).The levels of IL-1β,IL-6 and TNF-αat T_(1),T_(2)and T_(3)in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).At T_(1)and T_(2),the levels of cortisol in the two groups were higher than those at T_(0),the levels of cortisol in the two groups at T_(3)were lower than those at T_(0),at T_(1),T_(2)and T_(3),the levels of NE and E in the two groups were higher than those at T_(0),and the differences were statistically significa

关 键 词：右美托咪定 腰椎手术 自体血回输 炎症反应 应激反应 

分 类 号：R47[医药卫生—护理学]