| 罗 莹,韩宏雨,程守全,刘 冲,赵 鹏.不同剂量右美托咪定联合舒芬太尼对老年全髋关节置换术患者血流动力学、脑保护效应和 T淋巴细胞亚群的影响[J].,2022,(10):1869-1874 |
| 不同剂量右美托咪定联合舒芬太尼对老年全髋关节置换术患者血流动力学、脑保护效应和 T淋巴细胞亚群的影响 |
| Effects of Different Doses of Dexmedetomidine Combined with Sufentanil on Hemodynamics, Brain Protective Effect and T Lymphocyte Subsets in Elderly Patients Undergoing Total Hip Arthroplasty |
| 投稿时间：2021-11-10 修订日期：2021-11-30 |
| DOI：10.13241/j.cnki.pmb.2022.10.015 |
| 中文关键词: 右美托咪定 舒芬太尼 老年 全髋关节置换术 血流动力学 脑保护效应 T淋巴细胞亚群 |
| 英文关键词: Dexmedetomidine Sufentanil Elderly Total hip arthroplasty Hemodynamics Brain protective effect T lymphocyte subsets |
| 基金项目:吉林省卫生计生委自筹经费项目（2014ZC050） |
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| 中文摘要: |
| 摘要 目的：观察不同剂量右美托咪定联合舒芬太尼对老年全髋关节置换术（THA）患者血流动力学、脑保护效应和 T淋巴细胞亚群的影响。方法：选择2017年3月到2021年8月期间来我院接受治疗的老年THA患者90例。将患者根据随机数字表法分为低剂量组、中剂量组和高剂量组，例数分别为30例。麻醉诱导前，低剂量组（0.25 μg/kg）、中剂量组（0.50 μg/kg）和高剂量组（1.00 μg/kg）静脉输注右美托咪定，输注 10 min。观察三组血流动力学、脑保护效应指标、T淋巴细胞亚群指标、不良反应发生情况及镇痛情况。结果：中剂量组气管插管即刻（T1）~手术结束时（T3）时间点心率（HR）、平均动脉压（MAP）高于低剂量组和高剂量组（P<0.05）。高剂量组及中剂量组的术后2 h、术后 6 h、术后12 h、术后24 h疼痛视觉模拟评分法 (VAS )评分均低于低剂量组(P<0.05)，且高剂量组低于中剂量组( P<0.05 )。高剂量组、中剂量组术后3 d血清S100β蛋白、神经元特异性烯醇化酶（NSE）低于低剂量组，且高剂量组低于中剂量组（P<0.05）。高剂量组、中剂量组术后3 d的脑氧摄取率（CERO2）高于低剂量组，且高剂量组高于中剂量组（P<0.05）。高剂量组、中剂量组术后3 d CD3+、CD4+、CD4+/ CD8+高于低剂量组（P<0.05）。高剂量组、中剂量组术后3 d CD3+、CD4+、CD4+/ CD8+对比差异无统计学意义（P>0.05）。高剂量组的不良反应发生率比低剂量组和中剂量组的更高（P<0.05）。结论：右美托咪定联合舒芬太尼应用于老年THA患者，可获得较好的镇痛效果，且右美托咪定具有剂量差异，0.50 μg/kg及 1.00 μg/kg可获得相当的免疫功能恢复程度，0.50 μg/kg的患者血流动力学更稳定，而1.00 μg/kg的患者脑保护效应更好，但不良反应高，综合考虑，认为0.50 μg/kg右美托咪定相对更为安全。 |
| 英文摘要: |
| ABSTRACT Objective: To observe the effects of different doses of dexmedetomidine combined with sufentanil on hemodynamics, brain protective effect and T lymphocyte subsets in elderly patients undergoing total hip arthroplasty (THA). Methods: 90 elderly patients with THA who came to our hospital for treatment from March 2017 to August 2021 were selected The patients were randomly divided into low dose group, medium dose group and high dose group by the random number table method, with 30 cases respectively. Before anesthesia induction, dexmedetomidine was infused intravenously for 10 min in low dose group (0.25 μg/kg), medium dose group (0.50 μg/kg) and high dose group (1.00 μg/kg). Hemodynamics, brain protective effects, T lymphocyte subsets, adverse reactions and analgesia were observed in the three groups. Results: The heart rate (HR) and mean arterial pressure (MAP) at the time point of endotracheal intubation immediately (T1) to the end of surgery (T3) in the medium dose group were higher than those in the low dose group and the high dose group (P<0.05). The visual analogue scale (VAS) scores at 2 h, 6 h, 12 h and 24 h after operation in high dose group and medium dose group were lower than those in low dose group (P<0.05), and the high dose group was lower than the medium dose group (P<0.05). Serum S100β protein and neuron specific enolase (NSE) in high dose group and medium dose group were lower than those in low dose group, and high dose group was lower than the medium dose group (P<0.05). Cerebral oxygen uptake rate (CERO2) at 3 d after operation in high dose group and medium dose group were higher than that in low dose group, and the high dose group was higher than the medium dose group (P<0.05). CD3+, CD4+, CD4+/CD8+ at 3d after operation in high dose group and medium dose group were higher than those in low dose group (P<0.05). There were no significant differences in CD3+, CD4+, CD4+/CD8+ at 3 d after operation between the high dose group and the medium dose group (P>0.05). The incidence of adverse reactions in high dose group was higher than that in low dose group and medium dose group (P<0.05). Conclusion: Dexmedetomidine combined with sufentanil can achieve good analgesic effect in elderly patients with THA, and there is a difference in dosage of dexmedetomidine, 0.50 μg/kg and 1.00 μg/kg can achieve a comparable degree of immune function recovery, and patients with 0.50 μg/kg have more stable hemodynamics. However, 1.00 μg/kg patients have better brain protection effect, but high adverse reactions. Overall consideration, 0.50 μg/kg dexmedetomidine is relatively safer. |
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